Arrhythmogenic right ventricular cardiomyopathy (ARVC) mimics: the knot unravelled by cardiovascular MRI.

AIM: To assess the role of cardiovascular magnetic resonance imaging (CMRI) in patients referred for suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), its ability to identify ARVC mimics, and subsequent clinical impact. MATERIALS AND METHODS: The CMRI registry of the year 2014 was analysed to identify all consecutive patients referred for suspected ARVC. A comprehensive CMRI protocol that included anatomy, bi-ventricular function modules, and late gadolinium enhancement (LGE) was performed in all patients. RESULTS: Out of 2,481 CMRI performed, 124 patients (5%) were referred for suspected ARVC. A pathological substrate was identified at CMRI in 36 patients (29%): five patients (4%) had ischaemic heart disease (IHD) and 10 (8%) non-IHD; five patients (4%) met CMRI criteria for ARVC and 16 (13%) were ARVC mimics. right ventricular end-diastolic volume (RVEDV) and right ventricular stroke volume (RVSV) were significantly higher in patients with ARVC mimics (RVEDV p=0.007, RVSV p=0.012) and ARVC (RVEDV p=0.013, RVSV p=0.013), as compared to those with structurally normal hearts. CMRI was superior to echocardiography in the identification of ARVC mimics (13% versus 1%, p=0.01). CONCLUSIONS: CMRI was able to identify 16 (13%) ARVC mimics, from congenital abnormalities to acquired heart disease. CMRI was superior in identifying ARVC mimics compared to echocardiography, and overall provided a change in diagnosis in 22% of patients.

Diagnostic yield of cardiovascular magnetic resonance in young-middle aged patients with high-grade atrio-ventricular block.

BACKGROUND: Atrio-ventricular block (AVB) is a rare finding in young or middle-aged adults, often leading to pacemaker implantation (PM) without further investigation. We sought to assess the diagnostic role of cardiovascular magnetic resonance (CMR) in young and middle-aged adults with high-grade AVB. METHODS: We consecutively enrolled young-middle aged (18-65years) patients with high grade AVB referred to CMR after standard clinical assessment (history, electrocardiogram and cardiac rhythm monitoring) prior to PM implantation. Cine and post-contrast imaging were performed in a 1.5T scanner. RESULTS: 34 patients (59% male, mean age 42±12years) with high grade AVB were referred to CMR for suspected ischemic heart disease (IHD)(n=4) and non-ischemic heart disease (NIHD)(n=20); no clear cause was found in 9 patients prior to CMR and 1 patient had suspected lung disease. A pathologic substrate was found on CMR in 15 patients (44%), while a structurally normal heart was reported in 18 (53%). Non-specific findings were reported in 1 patient (3%). There was a fair agreement between CMR and echocardiographic findings (Cohen's kappa 0.243), and CMR provided an entirely new diagnosis in 34% of patients. As compared to the standard clinical assessment, CMR had an additional role in 65% of patients and guided further testing (genetic testing, extra-cardiac imaging) in 9%. CONCLUSIONS: CMR found a pathologic substrate in 44% of patients, mainly NIHD (32%). Half of the patients (53%) had a structurally normal heart. When added to the standard clinical assessment, CMR had an incremental diagnostic role in two thirds of patients.

Long-term efficacy of catheter ablation for atrial fibrillation: impact of additional targeting of fractionated electrograms.

OBJECTIVES: To investigate long-term efficacy of catheter ablation for atrial fibrillation (AF) and the impact of ablating complex or fractionated electrograms (CFEs) in addition to pulmonary vein isolation and linear lesions in persistent AF (PeAF). METHODS: Consecutive cases from 2002-2007 were analysed. All the patients underwent a wide-area circumferential ablation with confirmation of electrical isolation. For PeAF, linear lesions were added, with additional targeting of CFE from 2005. Data were collected in a prospective database. Attempts were made to contact all patients for follow-up. RESULTS: 285 patients underwent 530 procedures. The mean (SD) age was 57 (11) years, 75% were male, 20% had structural heart disease and 53% had paroxysmal AF (PAF). The mean number of procedures was 1.9 per patient (1.7 for PAF and 2.0 for PeAF). Procedural complications included stroke or transient ischemic attack in 0.6% and pericardial effusion requiring drainage in 1.7%. During 2.7 years (0.2 to 7.4 years) of follow-up from the last procedure, there were seven deaths (unrelated to their ablation or AF) and three strokes or transient ischemic attack (0.3% per year). Freedom from AF/atrial tachyarrhythmia was 86% for PAF and 68% for PeAF. Late recurrence was 3 per 100 years of follow-up after >3 years. The Kaplan-Meier analysis showed that CFE ablation improved the outcome for PeAF after the first cluster of procedures (p=0.049), with a trend towards improved final outcome (p=0.130). CONCLUSIONS: Long-term freedom from AF is achievable in most patients with PAF and PeAF with low rates of late recurrence. Additional targeting of CFE improves outcome for PeAF. Late adverse events including stroke are few.

Effect of selection for milk yield and dietary energy on yield traits, bovine somatotropin, and plasma urea nitrogen in dairy cows.

Effects of genetic merit on energy intake, milk yield, fat and protein percentages, BW, BW change, plasma concentration of bST, and plasma concentration of urea N were determined for 139 heifers. Heifers, daughters of bulls of high genetic merit (average +408 kg of PTA for milk) or of average genetic merit (average -153 kg of PTA for milk), were allotted to either a high or low energy diet. Heifers of high genetic merit yielded 8.1% more milk and had 7.7% higher bST concentration than did heifers of average genetic merit, which were 3% heavier than heifers of high genetic merit. There was no significant effect of genetic merit group on energy intake, plasma concentration of urea N, or percentages of fat and protein. Heifers fed the high energy diet consumed 35.1% more energy, yielded 11.8% more milk with a lower fat percentage, and weighed 3% more than did heifers fed the low energy diet. The high energy diet depressed bST concentration by 13.3% and plasma concentration of urea N by 14.2% compared with concentrations for heifers fed the low energy diet. Correlations among bST, BW, and energy intake were negative and significant. Correlations of bST concentration with milk yield, fat percentage, and protein percentage were not significant. Body weight, BW change, milk yield, and energy intake were negatively correlated with plasma concentration of urea N.

Development of adrenergic innervation of the iris and fluorescent ganglion cells in the choroid of the chick eye.

The developing innervation of the chick eye has been studied using catecholamine histofluorescence. The innervation of the pupillary dilator by the superior cervical ganglion begins on day 13 of incubation when fluorescent axons can be seen in the ciliary zone circumscribing the dilator. On day 14 a few processes are seen to branch from this band into the dilator. The number of processes in the dilator increases on days 15 and 16. After day 16 there is a reorganization of the fibers radially accompanied by a moderate increase in the number of processes. In addition, a group of fluorescent cells can be seen in the choroid adjacent to the ciliary body. These cells are bipolar at day 9 and become multipolar by 12 days of incubation. These cells contribute to a fluorescent plexus of processes in the choroid which stops abruptly at the border of the choroid and ciliary zone. It is thought that they represent a terminal sympathetic ganglion receiving preganglionic input from the carotid nerve.

An artifact of liquid emulsion autoradiography.

The localization of 3H-opiates in the myenteric plexus of the guinea pig ileum is subject to systematic artifact when stretch preparations of the myenteric plexus are dipped into liquid Kodak NTB-3 emulsion for autoradiography. The cause of the artifact was determined to be a discontinuous distribution, or retraction, of emulsion over plexuses. The apposition of frozen freeze-dried ileal sections to dried photographic emulsion avoids this source of error.

(3H)morphine localization in myenteric plexus.

Preferential binding of 3H-labeled morphine to satellite cells, but not to large neurons in the myenteric plexus, is demonstrated autoradiographically. Microfluorometric spectra of the plexus show nerve fibers that contain norepinephrine and impinge on satellite cells. Cells containing serotonin occur occasionally on longitudinal muscle outside the myenteric plexus.

( 3 H)lysergic acid diethylamide: cellular autoradiographic localization in rat brain.

Intravenous administration of [(3)H]lysergic acid diethylamide(LSD) to rats resulted in accumulation of the drug in the brain within 15 minutes. Autoradiographic methods were used to differentiate free and bound [(3)H]LSD in brain tissue. Free [(3)H]LSD was generally distributed in the pituitary and pineal glands, cerebellum, hippocampus,and choroid plexus. Bound [(3)H]LSD was localized in neurons of the cortex, caudate nucleus, midbrain, and medulla,as well as in choroid plexus epithelium.