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Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular dysfunction and ventricular arrhythmias (VA). Adequate arrhythmic risk assessment is important to prevent sudden cardiac death. We aimed to study the incremental value of strain by feature-tracking cardiac magnetic resonance imaging (FT-CMR) in predicting sustained VA in ARVC patients. Methods and results CMR images of 132 ARVC patients (43% male, 40.6 ± 16.0 years) without prior VA were analysed for global and regional right and left ventricular (RV, LV) strain. Primary outcome was sustained VA during follow-up. We performed multivariable regression assessing strain, in combination with (i) RV ejection fraction (EF); (ii) LVEF; and (iii) the ARVC risk calculator. False discovery rate adjusted P-values were given to correct for multiple comparisons and c-statistics were calculated for each model. During 4.3 (2.0–7.9) years of follow-up, 19% of patients experienced sustained VA. Compared to patients without VA, those with VA had significantly reduced RV longitudinal (P ≤ 0.03) and LV circumferential (P ≤ 0.04) strain. In addition, patients with VA had significantly reduced biventricular EF (P ≤ 0.02). After correcting for RVEF, LVEF, and the ARVC risk calculator separately in multivariable analysis, both RV and LV strain lost their significance [hazard ratio 1.03–1.18, P > 0.05]. Likewise, while strain improved the c-statistic in combination with RVEF, LVEF, and the ARVC risk calculator separately, this did not reach statistical significance (P ≥ 0.18). Conclusion Both RV longitudinal and LV circumferential strain are reduced in ARVC patients with sustained VA during follow-up. However, strain does not have incremental value over RVEF, LVEF, and the ARVC VA risk calculator.

Background/Introduction Specific athlete reference values for cardiac volumes and function using cardiac magnetic resonance (CMR) parameters have been reported and are used in clinical practice. Elite athletes are conventionally thought to demonstrate the highest levels of physiological adaptation to sports and therefore dictate the upper limit of normal for biventricular size and function in the athlete population. Purpose To compare volumetric parameters in a cohort of both male and female elite-level athletes to previously published reference values. Methods We used data from the prospective ELITE-cohort, which collects pre-participation data of elite athletes (national-, international-, Olympic-, Paralympic-level), including CMR imaging. Athletes suspected of pathology based on comprehensively investigated electrocardiograph, exercise test, echocardiogram and late gadolinium enhancement were excluded. Biventricular volumes were derived from short-axis cine images using Cvi42 (v5.1.2.) and indexed for body surface area (BSA). Volumetric parameters were compared to the previously reported gender- and Mitchell sports classification specific cardiac 95th percentile (95%tile) reference values, as reported by Luijkx et al.: left-ventricle (LV) end-diastolic volume (EDV) / BSA for high-static and high-dynamic sports (HS/HD; ♀ 142 ♂ 158); low-static and high-dynamic (LS/HD; ♀ 127 ♂ 149); high-static and low-dynamic (HS/LD; ♀ 114 ♂ 140); right ventricle (RV) EDV / BSA HS/HD (♀ 154 ♂ 184), LS/HD (♀ 136 ♂ 163), and HS/LD (♀ 120 ♂ 157). Results We analysed a total of 221 athletes (38% female), with a median age (IQR) of 26.0 (22.5–29.8) years, and mean ±SD BSA of 1.96±0.22 m2. Athletes were classified according to the Mitchell sports classification: HS/HD 116 (54%); LS/HD 61 (29%); moderate-static and high-dynamic (MS/HD) 20 (9.4%); HS/LD 16 (7.5%) (Table). We found smaller mean ±SD (95%tile) RV EDV/BSA in athletes participating in HS/HD sports (♀: 117±20 (148) and ♂: 133±20 (160)) and LS/HD sports (♀: 109±11 (129) and ♂: 119±15 (142)) and smaller LV EDV/BSA in male athletes in LS/HD sports (116±15 (138)) compared to reference values, (Figure). When using conventional cut-offs in our population we found 10 (4.5%) and 2 (0.9%) athletes above 95%tile for LVEDV/BSA and RVEDV/BSA, respectively (Figure). Conclusion In a cohort consisting of healthy, elite athletes, volumetric adaptations were less outspoken as compared with current reference ranges, specifically in the RV. Only 1 percent of our athletes exceeded conventional 95%tile references for the RV. Potentially, current athlete reference values could overestimate healthy upper limits of cardiac volumes in elite athletes. Our study could indicate that a stricter definition of volumetric reference values, including 95%tile, might be of added value in the specific group of elite athletes to help differentiate between pathology and sports adaptation. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Movement Sciences (P1A210AMC2018)

We compared velocity pulsatility, distensibility, and pulsatility attenuation along the intracranial ICA and MCA between 50 patients with pseudoxanthoma elasticum and 40 controls. Patients with pseudoxanthoma elasticum had higher pulsatility and lower distensibility at all measured locations, except for a similar distensibility at C4. The pulsatility attenuation over the siphon was similar between patients with pseudoxanthoma elasticum and controls. This finding suggests that other disease mechanisms are the main contributors to increased intracranial pulsatility in pseudoxanthoma elasticum.

Plasma osteoprotegerin (OPG) and vascular smooth muscle cell (VSMC) derived extracellular vesicles (EVs) are important regulators in the process of vascular calcification (VC). In population studies, high levels of OPG are associated with events. In animal studies, however, high OPG levels result in reduction of VC. VSMC-derived EVs are assumed to be responsible for OPG transport and VC but this role has not been studied. For this, we investigated the association between OPG in plasma and circulating EVs with coronary artery calcium (CAC) as surrogate for VC in symptomatic patients. We retrospectively assessed 742 patients undergoing myocardial perfusion imaging (MPI). CAC scores were determined on the MPI-CT images using a previously developed automated algorithm. Levels of OPG were quantified in plasma and two EV-subpopulations (LDL and TEX), using an electrochemiluminescence immunoassay. Circulating levels of OPG were independently associated with CAC scores in plasma; OR 1.39 (95% CI 1.17–1.65), and both EV populations; EV-LDL; OR 1.51 (95% CI 1.27–1.80) and EV-TEX; OR 1.21 (95% CI 1.02–1.42). High levels of OPG in plasma were independently associated with CAC scores in this symptomatic patient cohort. High levels of EV-derived OPG showed the same positive association with CAC scores, suggesting that EV-derived OPG mirrors the same pathophysiological process as plasma OPG.

Objective Reproductive disorders, such as premature ovarian insufficiency (POI) and polycystic ovary syndrome (PCOS), are associated with hormonal and metabolic changes, which might lead to changes in bone mineral density (BMD). On the one hand women with POI enter menopause too early and have less estrogen exposure rendering them more prone to develop low BMD. On the other hand women with PCOS, who often have a delayed menopause and therefore experience longer estrogen exposure, may have an increased BMD. A third reproductive disorder, preeclampsia (PE) does not seem to affect BMD or menopausal age. The effect of these reproductive disorders, with different menopausal ages, on BMD could be most evident in middle-aged women. We hypothesized that the duration of estrogen exposure is a key factor in BMD. Materials and methods In this cross-sectional study we compared the BMD of 258 women with a history of PE as a reference group (age 46.0; 40% postmenopausal) to 90 women with POI (age 48.1; 100% postmenopausal) and 84 women with PCOS (age 48.3; 26% postmenopausal). BMD was measured using non-contrast coronary CT scans in three consecutive thoracic vertebrae (in the T7-T10 range). Secondary outcomes included T-scores, prevalence of osteoporosis and osteopenia and the comparison of measured BMD to predicted BMD, calculated by a formula based on age. We performed linear regression analysis to assess differences in BMD between groups, adjusted for age and BMI. Results Compared to women with a history of PE, women with POI had lower BMD (p Conclusion Our results imply that prolonged estrogen exposure as in PCOS is associated with a higher BMD. A lower estrogen exposure associated with an early menopause in POI is associated with a lower BMD and osteoporosis. Patients with a history of PE could be seen as an intermediate group in terms of BMD and estrogen exposure, however, the measured BMD of women with a history of PE was higher than the predicted BMD. This study emphasizes the importance of adequate counseling on long term health issues when diagnosing a reproductive disorder. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

BackgroundAssessment of both coronary artery calcium(CAC) scores and myocardial perfusion imaging(MPI) in patients suspected of coronary artery disease(CAD) provides incremental prognostic information. We used an automated method to determine CAC scores on low-dose attenuation correction CT(LDACT) images gathered during MPI in one single assessment. The prognostic value of this automated CAC score is unknown, we therefore investigated the association of this automated CAC scores and major adverse cardiovascular events(MACE) in a large chest-pain cohort.MethodWe analyzed 747 symptomatic patients referred for 82RubidiumPET/CT, without a history of coronary revascularization. Ischemia was defined as a summed difference score≥2. We used a validated deep learning(DL) method to determine CAC scores. For survival analysis CAC scores were dichotomized as low(90 days after scanning) or nonfatal myocardial infarction. Cox proportional hazard analysis were performed to identify predictors of MACE.ResultsDuring 4 years follow-up, 115 MACEs were observed. High CAC scores showed higher cumulative event rates, irrespective of ischemia (nonischemic: 25.8% vs 11.9% and ischemic: 57.6% vs 23.4%, P-values ConclusionAutomatically derived CAC scores determined during a single imaging session are independently associated with MACE. This validated DL method could improve risk stratification and subsequently lead to more personalized treatment in patients suspected of CAD.

Additional file 2: Figure 1. Weighted mean T2* values and weighted standard deviations (SD) of the sub-analysis in patients with myocardial infarction and iron overload measured at 1.5 T (A) and 3 T (B). In myocardial infarction, T2* values of remote myocardium (r) (grey square), infarct core (c) (black square) and infarct zone (z) (black triangle) are presented. In iron overload, the T2* value of iron overload patients (p) with cardiac involvement is presented. The number of included measurements for each population is reported above the graph. MI myocardial infarction, IO iron overload. Figure 2. Weighted mean T2 values and weighted standard deviations (SD) of the sub-analysis in patients with myocardial infarction, heart transplantation and myocarditis measured at 1.5 T (A) and 3 T (B). In myocardial infarction, T2 values of remote myocardium (r) (grey square), infarct core (c) (black square) and infarct zone (z) (black triangle) are presented. In heart transplantation, T2 values of heart transplant recipients with negative rejection (n) (grey square) and positive rejection (p) (black square) are presented. In myocarditis, T2 values of populations scanned in the non-acute phase (n) (grey square) and in the acute phase (a) (black square) are presented. The number of included subjects for each population is reported above the graph. MI myocardial infarction, Trans heart transplantation, MC myocarditis.

Additional file 1.

BACKGROUND: Although several deep learning (DL) calcium scoring methods have achieved excellent performance for specific CT protocols, their performance in a range of CT examination types is unknown. PURPOSE: To evaluate the performance of a DL method for automatic calcium scoring across a wide range of CT examination types and to investigate whether the method can adapt to different types of CT examinations when representative images are added to the existing training data set. MATERIALS AND METHODS: The study included 7240 participants who underwent various types of nonenhanced CT examinations that included the heart: coronary artery calcium (CAC) scoring CT, diagnostic CT of the chest, PET attenuation correction CT, radiation therapy treatment planning CT, CAC screening CT, and low-dose CT of the chest. CAC and thoracic aorta calcification (TAC) were quantified using a convolutional neural network trained with (a) 1181 low-dose chest CT examinations (baseline), (b) a small set of examinations of the respective type supplemented to the baseline (data specific), and (c) a combination of examinations of all available types (combined). Supplemental training sets contained 199–568 CT images depending on the calcium burden of each population. The DL algorithm performance was evaluated with intraclass correlation coefficients (ICCs) between DL and manual (Agatston) CAC and (volume) TAC scoring and with linearly weighted κ values for cardiovascular risk categories (Agatston score; cardiovascular disease risk categories: 0, 1–10, 11–100, 101–400, >400). RESULTS: At baseline, the DL algorithm yielded ICCs of 0.79–0.97 for CAC and 0.66–0.98 for TAC across the range of different types of CT examinations. ICCs improved to 0.84–0.99 (CAC) and 0.92–0.99 (TAC) for CT protocol–specific training and to 0.85–0.99 (CAC) and 0.96–0.99 (TAC) for combined training. For assignment of cardiovascular disease risk category, the κ value for all test CT scans was 0.90 (95% confidence interval [CI]: 0.89, 0.91) for the baseline training. It increased to 0.92 (95% CI: 0.91, 0.93) for both data-specific and combined training. CONCLUSION: A deep learning calcium scoring algorithm for quantification of coronary and thoracic calcium was robust, despite substantial differences in CT protocol and variations in subject population. Augmenting the algorithm training with CT protocol–specific images further improved algorithm performance. © RSNA, 2020 See also the editorial by Vannier in this issue.

Introduction: Our aim was to compare infarct core volume on whole brain CT perfusion (CTP) with several limited coverage sizes (i.e., 3, 4, 6, and 8 cm), as currently used in routine clinical practice. Methods: In total, 40 acute ischemic stroke patients with non-contrast CT (NCCT) and CTP imaging of anterior circulation ischemia were included. Imaging was performed using a 320-multislice CT. Average volumes of infarct core of all simulated partial coverage sizes were calculated. Infarct core volume of each partial brain coverage was compared with infarct core volume of whole brain coverage and expressed using a percentage. To determine the optimal starting position for each simulated CTP coverage, the percentage of infarct coverage was calculated for every possible starting position of the simulated partial coverage in relation to Alberta Stroke Program Early CT Score in Acute Stroke Triage (ASPECTS 1) level. Results: Whole brain CTP coverage further increased the percentage of infarct core volume depicted by 10 % as compared to the 8-cm coverage when the bottom slice was positioned at the ASPECTS 1 level. Optimization of the position of the region of interest (ROI) in 3 cm, 4 cm, and 8 cm improved the percentage of infarct depicted by 4 % for the 8-cm, 7 % for the 4-cm, and 13 % for the 3-cm coverage size. Conclusion: This study shows that whole brain CTP is the optimal coverage for CTP with a substantial improvement in accuracy in quantifying infarct core size. In addition, our results suggest that the optimal position of the ROI in limited coverage depends on the size of the coverage.

Background: The aim of the current study was to determine the sensitivity and specificity of CT perfusion (CTP) for the detection of ischemic stroke by performing a systematic review and meta-analysis of published reports. Methods: We searched PubMed, Embase and the Cochrane library using the terms ‘perfusion computed tomography', ‘ischemic stroke' and synonyms. We included studies that: (1) reported original data, (2) studied the diagnostic value of CTP for detecting ischemic stroke, (3) used MRI-DWI, follow-up MRI or follow-up CT as the reference standard, (4) included at least 10 patients who were suspected of ischemic stroke, and (5) reported the number of true positives, true negatives, false positives and false negatives for the diagnosis of ischemic stroke. Results: Fifteen studies were finally included in the current review with a total of 1,107 patients. A pooled analysis resulted in a sensitivity of 80% (95% confidence interval, CI: 72-86%) and a specificity of 95% (95% CI: 86-98%). Almost two thirds of the false negatives were due to small lacunar infarcts; the remaining false negatives were mostly due to limited coverage. Conclusions: The current systematic review shows that CTP has a high sensitivity and a very high specificity for detecting infarcts.

Histopathologic findings in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) are replacement of the normal myocardium with fatty and fibrous elements with preferential involvement of the right ventricle. The right ventricular fibrosis can be visualised by post-gadolinium delayed enhancement inversion recovery imaging (DE imaging). We compared the image quality of three different gradient echo MRI sequences for short axis DE imaging of the right ventricle (RV). We retrospectively analysed MRI scans performed between February 2005 and December 2008 in 97 patients (mean age: 41.2 years, 67% men) suspected of ARVC/D. For DE imaging either a 2D Phase Sensitive (PSIR), a 2D (2D) or a 3D (3D) inversion recovery sequence was used in respectively 38, 32 and 27 MRI-examinations. The RV, divided in 10 segments, was assessed for image quality by two radiologists in random sequence. A consensus reading was performed if results differed between the two readings. Image quality was good in 24% of all segments in the 3D group, 66% in the 2D group and 79% in the PSIR group. Poor image quality was observed in 51% (3D), 10% (2D), and 2% (PSIR) of all segments. Exams were considered suitable for clinical use in 7% of exams in the 3D group, 75% of exams in the 2D group and 90% of exams of the PSIR group. Breathing-artifacts occurred in 22% (3D), 59% (2D) and 53% (PSIR). Motion-artifacts occurred in 56% (3D), 28% (2D) and 29% (PSIR). Post-gadolinium imaging using the PSIR sequence results in better and more consistent image quality of the RV compared to the 2D and 3D sequences.

Dear Sirs, In patients suspected of stroke it is important to make the correct diagnosis as soon as possible because thrombolysis might be indicated. We describe two cases with an acute neurological deficit suggestive of stroke. In both cases, noncontrast CT scans were compatible with cerebral ischaemia. However, perfusion CT showed hyperperfusion and the diagnosis cerebral ischaemia was rejected. These cases illustrate the value of perfusion CT in the diagnostic process of suspected ischaemia. Acute focal neurological deficit of cerebral origin is usually caused by ischaemic or hemorrhagic stroke. Less frequent other causes are hypoglycaemia, epilepsy, migraine, multiple sclerosis, intracranial neoplasms or somatoform disorders [1]. It is important to diagnose cerebral ischaemia as soon as possible because thrombolysis might be indicated. Perfusion CT might be of help in making a correct diagnosis in the hyperacute stage. The typical features of ischaemia on perfusion CT are decreased cerebral blood flow (CBF) and a prolonged mean transit time (MTT). Cerebral blood volume (CBV) may also be decreased, indicating irreversibility of the ischaemia. In most centres these perfusion abnormalities are reflected by a blue colour on the colour-coded perfusion maps [2]. We describe two patients with acute neurological deficit in whom perfusion CT made it possible to make a correct diagnosis in the hyperacute stage. An 84-year-old man with atrial fibrillation, hypertension and dyslipidemia presented with acute expressive aphasia and mild right-sided hemiparesis that existed for two and a half hours. He used warfarin because of atrial fibrillation, which was still present on the electrocardiogram. The international normalised ratio was 2.32 (optimal value: 3.00). Cerebral ischaemia was suspected. Noncontrast brain CT showed a left parietal hypodensity (Fig. 1d). Perfusion CT showed abnormalities in the same region, compatible with hyper- rather than hypoperfusion (Fig. 1a–c). MRI demonstrated a lesion, most likely being a high-grade glioma (Fig. 1e, f). The patient declined further investigations and he died 1 month later. Fig. 1 CT and MRI findings of patient 1. CT perfusion demonstrates an elevated cerebral blood volume (CBV) (a) and cerebral blood flow (CBF) (b) and a decreased mean transit time (MTT) (c) in the left parietal area, compatible with increased perfusion. Noncontrast ... A 71-year-old woman with diabetes mellitus type 2 presented with sudden dysarthria, hemianopsia and left-sided hemiparesis and neglect. Nine days earlier she had undergone right carotid endarterectomy because of a symptomatic stenosis greater than 70%. Blood pressure was 180/80 mm Hg and she had a regular pulse of 80 beats per minute. During examination, a generalised tonic–clonic seizure occurred. Noncontrast CT showed no new abnormalities as compared to MRI 2 months before. On CT angiography, the right internal carotid artery was patent (Fig. 2a, b). Perfusion CT showed asymmetry between the right and left hemispheres, with increased flow on the right (Fig. 2d–f). Cerebral hyperperfusion syndrome (CHS) was diagnosed and she was treated with antihypertensives. Fig. 2 CT and MRI findings of patient 2. Noncontrast CT shows periventricular white matter lesions (a). CT angiography shows a patent right carotid artery (b) and pronounced intracerebral arteries in the right hemisphere (c) Perfusion CT demonstrates an elevated ... One day later, MRI showed subcortical hyperintensities on the fluid attenuated inversion recovery (FLAIR) and T2-weighted sequence, but no hyperintensity on the diffusion-weighted sequence or corresponding hypointensity on the apparent diffusion coefficient (ADC) map (Fig. 2g–l). This ruled out new ischaemia and was compatible with CHS. These two cases illustrate that perfusion CT can help to identify causes other than cerebral ischaemia in patients with acute neurological deficit. The first case presented with symptoms compatible with acute cerebral ischaemia in the context of multiple vascular risk factors. Noncontrast CT showed an area of hypodensity, which can be an early sign of ischaemic stroke [3], although in this case it was already relatively pronounced in relation to symptom onset. In our patient, perfusion CT, with increased rather than decreased perfusion, suggested another cause. An intracranial neoplasm is diagnosed in 0.4% of patients with a transient neurological deficit [4]. Based on the clinical presentation it is not always possible to differentiate between transient attacks that are caused by a tumour or by a primarily vascular cause [5]. Neuroimaging is therefore necessary in patients with sudden focal neurological deficit of cerebral origin. However, it may still be impossible to differentiate cerebral ischaemia from a cerebral tumour on a noncontrast scan. In the second case, perfusion CT helped to differentiate CHS from ischaemia. Although the recent carotid endarterectomy and the seizure were suggestive for CHS [6], a firm distinction between CHS and ischaemia could not be made solely on the clinical findings and the noncontrast CT. Making this distinction had substantial consequences for treatment. The two cases illustrate the value of perfusion CT in the diagnostic process of suspected ischaemia. Perfusion CT can be obtained with most multidetector CT scanners with only a few minutes of additional scan-time [7]. Previous studies have established the accuracy of perfusion CT to detect ischaemic stroke [8]. Less is known about its capacity to differentiate between cerebral ischaemia and nonvascular causes of neurological deficits with a sudden onset. Case series now report perfusion abnormalities in stroke mimics, such as hyperperfusion in the context of seizures [9, 10]. Our two cases demonstrate that perfusion CT is also able to differentiate a tumour or CHS that presents with neurological deficits with a sudden onset from cerebral ischaemia in the acute stage. In both cases, perfusion CT demonstrated increased (red) rather than decreased (blue) flow. In other words, red flags that should have been blue.

Improved knowledge on risk factors for rupture of intracranial aneurysms may lead to more tailored aneurysm management. We studied whether configuration of the circle of Willis, direction of flow towards the aneurysm, and shape of the aneurysm are risk factors for rupture.We reviewed CT angiograms of 126 patients with 75 ruptured and 75 unruptured aneurysms, matched for site of the aneurysm, gender and age of the patient, and year of CT angiogram. For the characteristics studied, we calculated odd ratios (ORs) with corresponding 95% confidence intervals (CIs) for risk of rupture. Configuration of the circle of Willis (incompleteness, asymmetry or dominance) was analyzed on a per site basis. Non-spherical shape was subdivided into elliptical (oval and oblong) and multilobed. In additional analyses, we adjusted for size by means of multivariable logistic regression.Flow straight into the aneurysm (OR 2.0; 95% CI 1.0-4.1) and non-spherical shape (OR 2.8; 95% CI 1.5-5.5) were associated with rupture. Both elliptical shape, with increasing ORs for oval (OR 1.8; 95% CI 0.8-4.0) to oblong shape (OR 6.2; 95% CI 1.9-21), and multilobed shape (OR 4.1; 95% CI 1.2-14) were associated with rupture. These ORs decreased after adjustment for size. Configuration of the circle of Willis was not associated with a strong risk of rupture; moderate risk could not be excluded.Direction of flow into the aneurysm and nonspherical (both elliptical and multilobed) shape may contribute to the risk of rupture, but are related to aneurysm size and may warrant more frequent follow-up.

Aims To investigate the physiological adaptation of the right ventricle (RV) in response to endurance training and to define reference values for regional deformation in the RV in endurance athletes. Methods and results Healthy controls ( n = 61), athletes ( n = 58), and elite athletes ( n = 63) were prospectively enrolled with a training intensity of 2.2 ± 1.6, 12.5 ± 2.3 and 24.2 ± 5.7 h/week, respectively ( P < 0.001). Conventional echocardiographic parameters, tissue Doppler imaging (TDI), and 2D strain echo (2DSE)-derived velocity, strain, and strain rate (SR) were calculated in three RV segments. Left ventricular and RV dimensions were significantly increased ( P < 0.001) in both groups of athletes compared with controls. Right ventricular systolic velocities and displacement were not different between the groups. Right ventricular strain and SR values were reduced in the RV basal and mid-segment in athletes. Athletes with marked RV dilatation showed lower strain and SR values in the basal (−20.9 ± 4.7 vs. −24.5 ± 4.9%, P < 0.001 and −1.23 ± 0.31 vs. −1.50 ± 0.33 s−1, P < 0.001) and mid (−29.3 ± 5.4 vs. −32.1 ± 5.3%, P = 0.017 and −1.58 ± 0.41 vs. −1.82 ± 0.42 s−1, P = 0.009) segment, whereas athletes without RV dilatation showed no significant difference compared with the controls. Conclusion Regional deformation and deformation rates (TDI and 2DSE) are reduced in the basal RV segment in athletes. This phenomenon is most pronounced in athletes with RV dilatation and should be interpreted as normal when evaluating athletes suspected for RV pathology.

Aims To determine whether peri-coronary epicardial adipose tissue (EAT) is associated with vascular risk factors and coronary atherosclerosis. Methods and results In this study, 573 healthy post-menopausal women underwent a cardiac CT scan to assess coronary calcification. Peri-coronary EAT thickness was measured in the areas of right coronary artery (RCA), left anterior descending (LAD) artery, and left circumflex (LCX) coronary artery. Average EAT thickness was 16.5 ± 4.3 mm (range 5.9–34.6) in the RCA area, 6.4 ± 2.2 mm (range 2.0–14.0) in the LAD area, and 10.8 ± 3.0 mm (range 2.8–29.1) in the LCX area. Overall average thickness was 11.2 ± 2.2 mm (range 5.4–19.1). EAT was positively related to age ( P = 0.002). In age-adjusted linear regression models, EAT was positively related to weight ( P < 0.001), waist circumference ( P < 0.001), waist-to-hip ratio ( P < 0.001), body mass index ( P < 0.001), glucose ( P < 0.001), triglycerides ( P = 0.001), use of anti-hypertensive drugs ( P = 0.007), and systolic blood pressure ( P = 0.034), and inversely to HDL cholesterol ( P = 0.005). In multivariable models, age, weight, waist circumference, smoking, and glucose were the main determinants of EAT. EAT showed a graded relation with coronary calcification ( P = 0.026). Conclusion EAT is strongly related to vascular risk factors and coronary calcification. Our findings support the hypothesis that EAT affects coronary atherosclerosis and possibly coronary risk.

BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatment strategies. This study aimed to identify variables associated with the development of prominent edema in patients with large MCA infarcts. MATERIALS AND METHODS: From the Dutch Acute Stroke Study (DUST), 137 patients were selected with large MCA infarcts on follow-up NCCT (3 ± 2 days after stroke onset), defined as ASPECTS ≤4. Prominent edema was defined as a midline shift of ≥5 mm on follow-up. Admission patient and treatment characteristics were collected. Admission CT parameters used were ASPECTS on NCCT and CBV and MTT maps, and occlusion site, clot burden, and collaterals on CTA. Permeability on admission CTP, and day 3 recanalization and reperfusion statuses were obtained if available. Unadjusted and adjusted (age and NIHSS) odds ratios were calculated for all variables in relation to prominent edema. RESULTS: Prominent edema developed in 51 patients (37%). Adjusted odds ratios for prominent edema were higher with lower ASPECTS on NCCT (adjusted odds ratio, 1.32; 95% CI, 1.13–1.55) and CBV (adjusted odds ratio, 1.26; 95% CI, 1.07–1.49), higher permeability (adjusted odds ratio, 2.35; 95% CI, 1.30–4.24), more proximal thrombus location (adjusted odds ratio, 3.40; 95% CI, 1.57–7.37), higher clot burden (adjusted odds ratio, 2.88; 95% CI, 1.11–7.45), and poor collaterals (adjusted odds ratio, 3.93; 95% CI, 1.78–8.69). CONCLUSIONS: Extensive proximal occlusion, poor collaterals, and larger ischemic deficits with higher permeability play a role in the development of prominent edema in large MCA infarcts.

Left ventricular hypertrophy (LVH) is an independent risk factor for the development of heart failure, coronary heart disease and stroke. LVH develops in response to haemodynamic overload, e.g. hypertension. LVH was originally thought to start as an adaptive and beneficial response required to normalise wall stress. However, this concept has been challenged by recent animal experiments suggesting that any degree of LVH is detrimental for the preservation of cardiac function and survival. If confirmed in humans, these findings imply that an increase in LV mass should be prevented, e.g. by lifestyle or pharmacological interventions. To facilitate and optimise interventions, the SMART Heart study was recently set up to develop a prediction model, also involving single nucleotide polymorphism data, for the identification of subjects at high risk of developing LVH in hypertension. For this purpose 1000 subjects with chronic hypertension will undergo cardiac MR imaging. In addition, this study allows the extrapolation of animal experimental genetic research into the human situation. (Neth Heart J 2007;15:295-8.18030317).

Purpose: To assess the presence of anterior and posterior collateral pathways in the circle of Willis in patients with symptomatic carotid artery stenosis (SCAS) and to compare this to patients without carotid artery stenosis. Materials and Methods: Multislice CT angiography was performed in 91 patients and 91 control subjects. Using consensus reading, 2 observers evaluated the presence and diameter of the anterior communicating artery (AcomA), the A1 segments of the anterior cerebral arteries, the posterior communicating arteries (PcomA) and the P1 segments of the posterior cerebral arteries. Anterior or posterior pathways were assumed to be present if the diameter of continuous arterial segments was >1 mm; both A1 segments and AcomA anterior, and ipsilateral P1 segment and PcomA posterior. Comparison between patients and controls was performed using the χ2 test. Results: In the patients we found significantly more hypoplastic (Conclusion: A compromised anterior collateral pathway, usually combined with a compromised posterior pathway, occurs more frequently in patients with SCAS as compared to controls, which suggests a relation between symptomatic carotid stenosis and an incomplete circle of Willis.

Background: Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult to predict. The authors studied the relation between several parameters of brain perfusion at admission and development of DCI. Methods: The authors analyzed the admission CT perfusion (CTP) scans of 46 patients scanned within 72 hours after SAH. They assessed cerebral blood volume (CBV) and flow (CBF), mean transit time (MTT), and time to peak (TTP) for eight predefined regions of interest. For patients with and without DCI, the authors compared perfusion quantitatively and semiquantitatively. With receiver-operator characteristic (ROC) curves, the authors assessed the relationship between DCI and perfusion parameters. To assess the potential prognostic value, they calculated sensitivity and specificity of optimal threshold values for the semiquantitative data. Results: DCI was not significantly related with quantitative perfusion values. For the semiquantitative data, patients with DCI had significantly more asymmetry in perfusion, and ROC curves indicated a good relation (0.75 to 0.81). Optimal threshold values distinguishing between patients with and without DCI were 0.77 for CBV and 0.72 for CBF ratios, and 0.87 seconds for MTT and 1.0 second for TTP differences. The corresponding sensitivity was 0.75 for all parameters; the specificity was 0.70 for CBV, 0.93 for CBF, 0.70 for MTT, and 0.90 for TTP. Conclusions: Delayed cerebral ischemia (DCI) is related to perfusion asymmetry on admission CT perfusion (CTP). The cerebral blood flow ratio (comparing contralateral regions of interest) seems the best prognosticator for development of DCI. Further studies are needed to investigate the additional value of CTP to other prognosticators for DCI and to validate the chosen threshold values.

Background and Purpose— In perimesencephalic nonaneurysmal hemorrhage (PMH), subarachnoid blood accumulates around the midbrain. Clinical and radiological characteristics suggest a venous origin of PMH. We compared the venous drainage of the midbrain between patients with PMH and aneurysmal subarachnoid hemorrhage (aSAH) by means of computed tomography angiography (CTA). Methods— CTAs of 55 PMH patients and 42 aSAH patients with a posterior circulation aneurysm were reviewed. Venous drainage was classified into: (1) normal continuous: the basal vein of Rosenthal is continuous with the deep middle cerebral vein and drains mainly to the vein of Galen (VG); (2) normal discontinuous: drainage anterior to uncal veins and posterior to VG; and (3) primitive variant: drainage to other veins than VG. Additionally, we compared in PMH patients the side of the primitive variant and side of the bleeding. Results— A primitive variant was present on one or both hemispheres in 53% of PMH patients with PMH (95% CI, 40% to 65%) and in 19% of aSAH patients (95% CI, 10% to 33%). In all 16 PMH patients with a unilateral primitive drainage, blood was seen on the side of the primitive drainage (100%; 95% CI, 81% to 100%); blood was never found mainly on the side with normal drainage. Conclusions— Patients with PMH have a primitive venous drainage directly into dural sinuses instead of via the vein of Galen more often than do controls. Moreover, the side of the perimesencephalic hemorrhage relates to the side of the primitive drainage. These results further support a venous origin of PMH.

Persistent left superior vena cava (LSVC) is the most common congenital systemic venous anomaly, which may give rise to several problems. We present a case in which a persistent LSVC was an unsuspected finding. A 70-year-old male presented with intracerebral empyema which may have been caused by venous septic emboli from the left arm and facilitated by a persistent LSVC draining directly into the left atrium. Visualisation of the anomaly was performed with echocardiography and magnetic resonance angiography. In addition we present a brief review of the literature concerning this disorder.

Objective: The objective was to assess the risk of aneurysmal subarachnoid hemorrhage (aSAH) in the initial 15 years after negative aneurysm screening in persons with one first-degree relative with aSAH. Methods: From a cohort of first-degree relatives of patients with aSAH who underwent screening between 1995 and 1997 (n = 626), we included those with a negative screening (n = 601). We retrieved all causes of death and sent a questionnaire to screenees who were still alive. If aSAH was reported, we reviewed all medical data. We assessed the incidence of aSAH in this cohort with survival analysis and calculated an incidence ratio by dividing the observed incidence with the age- and sex-adjusted incidence in the general population. Results: Of the 601 screenees, 3 had aSAH during 8,938 follow-up patient-years (mean 14.9 years). After 15 years, the cumulative incidence was 0.50% (95% confidence interval: 0.00%–1.06%) with an incidence rate of 33.6 per 100,000 person-years; the incidence rate ratio was 1.7 (95% confidence interval: 0.3–5.7). Conclusions: In the first 15 years after a negative screening, the risk of aSAH in persons with one first-degree relative with aSAH is not nil, but in the range of that in the general population, or even higher. Whether this finding justifies serial aneurysm screening in this population requires further study.

Purpose In brain CT perfusion (CTP), the arterial contrast bolus is scaled to have the same area under the curve (AUC) as the venous outflow to correct for partial volume effects (PVE). This scaling is based on the assumption that large veins are unaffected by PVE. Measurement of the internal carotid artery (ICA), usually unaffected by PVE due to its large diameter, may avoid the need for partial volume correction. The aims of this work are to examine i) the assumptions behind PVE correction and ii) the potential of selecting the ICA obviating correction for PVE. Methods The AUC of the ICA and sagittal sinus were measured in CTP datasets from 52 patients. The AUCs were determined by i) using commercial CTP software based on a Gaussian curve-fitting to the time attenuation curve, and ii) by simple integration of the time attenuation curve over a time interval. In addition, frames acquired up to 3 minutes after first bolus passage were used to examine the ratio of arterial and venous enhancement. The impact of selecting the ICA without PVE correction was illustrated by reporting cerebral blood volume (CBV) measurements. Results In 49 of 52 patients, the AUC of the ICA was significantly larger than that of the sagittal sinus (p = 0.017). Measured after the first pass bolus, contrast enhancement remained 50% higher in the ICA just after the first pass bolus, and 30% higher 3 minutes later. CBV measurements were significantly lowered when the ICA was used without PVE correction. Conclusions Contradicting the assumptions underlying PVE correction, contrast in the ICA was significantly higher than in the sagittal sinus, even 3 minutes after the first pass of the contrast bolus. PVE correction might lead to overestimation of CBV if the CBV is calculated using the AUC of the time attenuation curves.

Background: In stroke erythrocyte-rich thrombi are more sensitive to intravenous thrombolysis with recombinant tissue plasminogen activator (IV-rtPA) and have higher density on non-contrast CT (NCCT). We investigated the relationship between thrombus density and recanalization and whether persistent occlusions can be predicted by Hounsfield unit (HU) measurements. Methods: In 88 IV-rtPA-treated patients with intracranial ICA or MCA occluding thrombus and follow-up imaging, thrombus and contralateral vessel attenuation measurements were performed on thin-slice NCCT. Mean absolute and relative HU were compared between patients with persistent occlusion (modified Thrombolysis in Cerebral Infarction system, grade 0/1/2a) and recanalization (grade 2b/3). Univariate and multivariate (adjusted for stroke subtype, clot burden score, occlusion site and time to thrombolysis) odds ratios for persistent occlusion were calculated. Additional prognostic value for persistent occlusion was estimated by adding HU measurements to the area under the curve (AUC) of known determinants and calculating optimal cut-off values. Results: Patients with persistent occlusion (n = 19) had significant lower mean HU (absolute 52.2 ± 9.5, relative 1.29 ± 0.20) compared to recanalization (absolute 63.1 ± 10.7, relative 1.54 ± 0.23, both p < 0.0001). Odds ratios for persistent occlusion were 3.1 (95% confidence interval, CI 1.6-6.0) univariate and 3.1 (95% CI 1.7-5.7) multivariate per 10 absolute HU decrease and 3.2 (95% CI 1.6-6.5) univariate and 4.1 (95% CI 1.8-9.1) multivariate per 0.20 relative HU decrease. Attenuation measurements significantly increased the AUC (0.67) of the known determinants to 0.84 (absolute HU) and 0.86 (relative HU). Cut-off values of Conclusions: Thrombus density is related to recanalization rate. Lower absolute and relative HU are independently related to persistent occlusion and HU measurements significantly increase discriminative performances of known recanalization determinants.

Aim Increasing evidence suggests an important role for hyperactivation of the sympathetic nervous system (SNS) in the clinical phenomena of heart failure with normal LVEF (HFNEF) and hypertension. Moreover, the level of renal sympathetic activation is directly related to the severity of heart failure. Since percutaneous renal denervation (pRDN) has been shown to be effective in modulating elevated SNS activity in patients with hypertension, it can be hypothesized that pRDN has a positive effect on HFNEF. The DIASTOLE trial will investigate whether renal sympathetic denervation influences parameters of HFNEF. Methods DIASTOLE is a multicentre, randomized controlled trial. Sixty patients, diagnosed with HFNEF and treated for hypertension, will be randomly allocated in a 1:1 ratio to undergo renal denervation on top of medical treatment (n = 30) or to maintain medical treatment alone (n = 30). The primary objective is to investigate the efficacy of pRDN by means of pulsed wave Doppler echocardiographic parameters. Secondary objectives include safety of pRDN and a comparison of changes in the following parameters after pRDN: LV mass, LV volume, LVEF, and left atrial volume as determined by magnetic resonance imaging. Also, MIBG (metaiodobenzylguanidine) uptake and washout, BNP levels, blood pressure, heart rate variability, exercise capacity, and quality of life will be assessed. Perspective DIASTOLE is a randomized controlled trial evaluating renal denervation as a treatment option for HFNEF. The results of the current trial will provide important information regarding the treatment of HFNEF, and therefore may have major impact on future therapeutic strategies. Trail registration NCT01583881.

Background: Because the pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is unclear, we studied cerebral perfusion at different time points around the occurrence of DCI. Methods: We prospectively enrolled 53 patients admitted to the University Medical Center Utrecht who underwent CT perfusion (CTP) scans on admission, and within 2 weeks after hemorrhage on 2 scheduled time points or during clinical deterioration. The occurrence of DCI was assessed according to predefined criteria by 2 neurological observers blinded to perfusion results. Clinically stable patients (no-DCI) served as reference, and patients with other causes of deterioration (n = 11) were excluded. In DCI patients, the day of DCI onset and in no-DCI patients the median day of DCI onset was taken as t = 0. Scans made before and after DCI were clustered into 5 additional time points. At each time point, cerebral blood volume (CBV) and flow (CBF), and mean transit time (MTT) were measured, and absolute and relative (interhemispheric asymmetry) values were compared between DCI and no-DCI patients. Results: Absolute CBF was lower and MTT was higher in the 18 DCI patients than in the 24 no-DCI patients before, during and after DCI. MTT asymmetry increased during DCI and partially recovered afterwards in DCI patients while it remained constant in no-DCI patients. Absolute and relative CBV remained constant in both groups. Conclusions: Our findings suggest that DCI patients already have diffusely worse perfusion (absolute values) than no-DCI patients before focal worsening (increased asymmetry) occurs and becomes symptomatic. The partial recovery in the measured areas suggests that DCI can be partly reversible.

Advanced cardiac imaging, using cardiac magnetic resonance imaging (MRI) and multidetector computed tomography (CT), is increasingly used in the work-up of athletes with suspected abnormalities on screening. Both imaging modalities produce highly accurate and reproducible structural and functional cardiac information. Cardiac MRI has the advantage of imaging without radiation exposure or the use of iodine-containing contrast agents, but is sometimes not possible due to claustrophobia or other contraindications. Although cardiac MRI can rule out coronary artery anomalies, multidetector CT is superior to cardiac MRI for visualising the full extent of the coronary arteries and atherosclerotic coronary artery disease. For patients less than 35 years of age, cardiac MRI is the first option after initial echocardiography for further assessment of cardiomyopathies, myocarditis and coronary anomalies, which are major causes of sudden cardiac death in young athletes. For athletes over 35 years of age the most common cause of sudden cardiac death is coronary artery disease, whereby cardiovascular screening requires further diagnostic modalities and may include multidetector CT.

Objective: To investigate the prevalence and determinants of unrecognized myocardial infarction (UMI). Design, setting, patients: In this cross-sectional study in a tertiary centre a delayed enhancement cardiac MRI (DE-CMR), which identifies both Q-wave and non-Q wave MIs, was performed in 502 subjects with manifest extra-cardiac atherosclerotic disease or marked risk factors for atherosclerosis without symptomatic coronary artery disease. Main outcome measures: UMI was defined as the presence of delayed enhancement without corresponding clinical history. Results: DE-CMR was of sufficient image quality in 480 (95.6%) subjects. An UMI was present in 45 (9.4%) of all subjects; in 13.1% of men and in 3.7% of women. The risk of UMI increased from 6.0% (95%CI 2.2-9.8%) in those with 2 vascular risk factors up to 26.2% (95%CI 15.2-37.3%) in those with 4 or 5 risk factors. In multivariable analysis the risk of UMI was related to male gender (OR 2.3 (95%CI 1.0-5.6)), age (OR 1.04 (95%CI 1.00-1.07) per year), ever smoking (OR 3.1 (95%CI 1.0-9.1), history of stroke (OR 1.9 (95%CI 0.8-4.3)) and history of aneurysm of the abdominal aorta (OR 2.6 (95%CI 1.0-6.9)). Conclusions: In cardiac asymptomatic subjects at high vascular risk UMI is common. The risk of UMI increases with increasing presence of risk factors.

Few risk factors have been identified for rebleeding in patients with subarachnoid haemorrhage. We studied whether size of aneurysm after rupture is a risk factor for rebleeding. Since intracranial aneurysms develop during life and may therefore be larger at an older age, we also assessed whether age confounds a relation between size and rebleeding.We studied all patients with aneurysmal subarachnoid haemorrhage admitted between 1995 and 2000. Since 1995 CT-angiography is obtained in all patients on admission. Patients were followed until rebleeding, operation, discharge or death. For the relation between size and risk of rebleeding we used Cox proportional hazards modelling.We included 354 patients. Rebleeding occurred in 22 (30%) of the 73 patients with a large (10 mm) aneurysm, and in 68 (24%) of the 281 patients with a small (or =10 mm) aneurysm (hazard ratio for large aneurysms 1.6 (95% confidence interval [CI] 1.0-2.6)). Within the first three days rebleeding occurred in 14 (19.2%) patients with a large aneurysm and in 25 (8.9%) patients with a small aneurysm (hazard ratio 2.4 (95% CI 1.2-4.5)). After adjustment for age, all hazard ratios remained essentially the same.Patients with large aneurysms have a higher risk for rebleeding, in particular within the first three days after the initial haemorrhage. This increased risk is independent of age.

Lipomatous hypertrophy of the interatrial septum is a benign disorder that is characterized by the fat deposition in the interatrial septum. It typically occurs in elderly, obese patients and may cause arrhythmia. We report a case in which lipomatous hypertrophy of the interatrial septum was found incidentally.

We report a case of acute myocarditis in a 20-year-old male, suggested by the clinical picture, elevated cardiac enzymes, electrocardiography and serology. Diagnosis was confirmed by gadolinium-enhanced MRI showing part of the myocardium affected by an infiltrate. Impaired LV function and wall motion abnormalities were documented by echocardiography and FFE MRI. The patient recovered well within two weeks, but will be followed intensively since dilated cardiomyopathy may ensue.

OBJECTIVE. The purpose of this study was to evaluate CT angiography source images and to assess various postprocessing techniques for cerebral aneurysm detection in daily practice. MATERIALS AND METHODS. We retrospectively studied 17 patients who underwent digital subtraction angiography and CT angiography for possible cerebral aneurysms. Four observers assessed CT angiography data for aneurysms, first after viewing source images in cine mode and again after consecutively adding postprocessing techniques in the following order: maximum intensity projection (MIP) of a 2-cm slab without bone editing (slab-MIP), taking 3 min of operator time; MIP with bone editing (edited-MIP), taking 20 min; shaded-surface display (SSD) without bone editing (3 min); and SSD with bone editing (20 min). In addition, the observers stated which postprocessing method they preferred. RESULTS. In nine patients, we found 13 aneurysms, 10 of which were larger than 5 mm in size. Sensitivity for detection of aneurysms on CT angiography was 92% for three observers and 77% for one observer. Specificity was 100% for two observers and 78% for two observers. Using four observers in a pooled analysis, the maximum of positive readings was 52. CT angiography was positive in 46 of these 52 instances: 41 positive readings after source image viewing, five additional positive readings after adding MIP, and no additional positive readings after adding SSD. Overall, MIP was judged superior to SSD and slab-MIP was judged to be better than edited-MIP. CONCLUSION. In this study interactive source image viewing detected most cerebral aneurysms. Additional slab-MIP is an efficient postprocessing technique for display much like that of angiography, for verification of aneurysms found, and for detection of additional aneurysms. These conclusions need to be verified in a larger study group.

Computed tomographic angiography (CTA) is a vascular imaging technique based on the rapid acquisition of volumetric CT data during the bolus phase of intravenously administered contrast [1–3]. CTA is a recent diagnostic technique and is still under development. Only preliminary studies on its diagnostic value have been performed. In this chapter the technique is described and the clinical experience of various research groups with a number of specific CTA applications is discussed. The latest generation of CT scanners are equiped with slip-ring current and data transfer. This makes it possible to rotate the assembly of X-ray tube and X-ray detectors continuously. During this continuous rotation the patient can be moved at a constant speed through the plane of the X-ray tube and detectors.

was higher in the NRG (p 0.70 was the more accurate RT-MCE value to predict LV regional recovery with positive predictive value of 70% and negative predictive value of 56% (p

Inthelastdecadesseveralinvestigatorshavesuggestedtheassociationofandrogenswithhypertension. Recently, some studies have shown that the incidence of cardiovascular diseases is increased in men with low testosterone levels, suggesting a protective role of androgens. Hypertension is one of the mostcommonproblemsinpregnancythatcomplicates5-10 %ofpregnancies.Anincreaseofmorbidity wasobservedinbabiesfrompregnantwomenwithhypertension.However,thepathogenesisremains unclearandthislimitstheabilitytopreventandtreatthispathology.Thebeneficialeffectsofandrogens for vascular system are associated with their ability to cause vasorelaxation. Inhuman vessels, this non genomiceffectofandrogensappeartobeduetoactivationoflargeconductancecalcium-activatedpotassiumchannels(BKCa)andvoltagegatedpotassiumchannels(KV)whichisinducedbycGMPincrease andaconsequentactivationofcGMP-dependentproteinkinase(PKG).Ontheotherhand,thegenomic effects of androgens concerning ionic channels are almost unknown. Our previous studies suggested that androgens increase the expression of BKCa channels and decrease expression of L-type calcium channels (LTCC). The aim of this work was to analyze the genomic effects of androgens on theexpressionofotherproteinsinvolvedintheregulationofvascularcontractility,suchassolubleguanylate cyclase (sGC), the natriuretic peptide receptor-A (NPRA) and PKG. This study also aimed to compare the expression levels of these proteins in human umbilical artery (HUA) from normotensive andhypertensivepregnantwomen.ToachievethesegoalsrealtimePCRwasperformedusingsmooth

Background: Left ventricular hypertrophy (LVH) is often observed in athletes, which should be differentiated from hypertrophic cardiomyopathy. The aim of the study was to explore the functional changes measured using tissue Doppler imaging (TDI) deformation analysis in athletes fulfilling LVH criteria participating in different endurance sports. Methods: Healthy controls (n = 62, 58% men) and endurance athletes (n = 120, 62% men) aged 18-40 years were prospectively enrolled and underwent both standard echocardiography as well as TDI. Longitudinal TDI-derived strain and strain rate (SR) were calculated in the septal and posterior wall in three segments. LVH was defined as a left ventricular mass (LVM) over 132 g/m2 in men and over 109 g/m 2 in women. Results: Echocardiographic LVH was observed in 33 athletes (67% men). LVM was significantly increased in both athlete groups (102.6 g/m2 (SD 16.0) and 135.7 g/m2 (SD 15.9) vs 88.0 g/m2 (SD 16.5) in controls, p< 0.001). Diastolic parameters were not significantly different between groups. Athletes with LVH showed no significant difference in strain and SR values in any segment of the septal or posterior wall compared with controls or those without LVH. A weak but significant correlation (also after multivariate analysis) was found for septal wall thickness and LVM in peak systolic strain (r = 0.26, p

Objectives: In patients with previous subarachnoid haemorrhage (SAH) undergoing follow up screening, the authors assessed the impact of finding but not treating very small aneurysms by comparing quality of life (QOL), anxiety, and depression between patients with a newly detected aneurysm that was left untreated (cases) and patients with a negative screening (controls) as this should be incorporated in the evaluation of effectiveness of screening. Methods: In patients with previous SAH undergoing screening for new aneurysms the authors compared QOL (SF-36, EURO-QOL, and a screening related questionnaire), anxiety, and depression (Hospital Anxiety and Depression Scale (HADS)) between cases and controls. Differences in scores on the SF-36, EURO-QOL, and HADS were assessed with Student’s t test and differences in proportions of patients with HADS scores in the pathological range and screening related changes with χ 2 analysis. The authors powered the study to detect a moderate, clinically relevant difference. Results: Thirty five cases and 34 controls were included. Trends for health related QOL, anxiety, depression, and consequences in daily life pointed in the same direction of a less favourable situation for cases but all effects were small, and did not reach statistical significance. On the screenings specific questionnaire, cases more often (but not statistically significant) reported changes in daily life. Conclusions: The authors found no major or moderate impact on QOL, anxiety, and depression of the awareness of having an untreated aneurysm, which was detected at screening, although most items showed a trend towards more negative effects for cases. Minor effects on individual level cannot be excluded by this study.