No abstract

Background-MRI-detected brain lesions are common after left atrial catheter ablation for symptomatic atrial fibrillation.The clinical relevance of these acute ischemic lesions is not fully understood, but ablation-related cerebral injury could contribute to cognitive dysfunction. .5; interquartile range, 6-7) revealed that 7 (12.5%) of the 56 total acute brain lesions after ablation formed a persistent glial scar in 5 (31.3%) patients. Large diffusion-weighted imaging lesions and a corresponding fluid-attenuated inversion recovery lesion 48 hours after ablation predicted lesion persistence on 6-month follow-up. Neither persistent brain lesions nor the ablation procedure itself had a significant effect on attention or executive functions, short-term memory, or verbal and nonverbal learning after 6 months. Conclusions-Ablation-related acute ischemic brain lesions persist to some extent but do not cause cognitive impairment 6 months after the ablation procedure. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01061931.(Circ Arrhythm Electrophysiol. 2013;6:843-850.)

E tiologic work-up is essential in patients with acute ischemic stroke to optimize secondary stroke prevention. According to international guidelines, state-of-the-art diagnostic work-up includes brain imaging, ultrasound of brainsupplying arteries, echocardiography, ECG monitoring, and distinct blood tests.1,2 However, stroke etiology remains undetermined (cryptogenic) in about 25% of all acute ischemic stroke patients. 3 Apart from nonpermanent atrial fibrillation (AF), 4 ventricular noncompaction, left atrial or ventricular thrombi, mitral or aortic valve stenosis, and ulcerated aortic arch atherosclerotic plaques are associated with a moderate to high embolic stroke risk and were found in a substantial part Background and Purpose-Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. Methods-One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke. Despite interstudy variations on the definition and prevalence of (potential) embolic sources, current guidelines recommend diagnostic echocardiography in stroke patients. 2Although noninvasive transthoracic echocardiography (TTE) is easy to use, semi-invasive transesophageal echocardiography (TEE) is typically needed to visualize the left atrium, left atrial appendage, atrial shunts, and the aortic arch-all of them potential sources of embolism.6 Serious complications during TEE rarely occur.7 However, required preprocedural fasting, periprocedural conscious sedation, and the demand of highly skilled personnel limit its availability and cause in-hospital delays. 8 In consequence, TEE is not routinely performed in (cryptogenic) stroke patients, even in high-income countries.9 Subsequently, assessment of potential embolic sources of ischemic stroke is often inappropriate in clinical practice. Although cardiac computed tomography could add information about stroke etiology, 10 the main disadvantage of this approach is the exposure to radiation. Cardiac magnetic resonance imaging (MRI) has been increasingly often implemented in the clinical diagnostic workflow of various cardiac diseases over the past 10 years and allows for accurate biventricular functional analysis and tissue characterization. Cardiac MRI is now considered the gold standard to assess cardiac tumors, myocarditis, cardiomyopathies, and subclinical coronary heart disease. 11,12 In addition, cardiac MRI has demonstrated feasibility of detecting atrial or ventricular thrombi, 13 aortic atherosclerotic plaques, 14,15 or left atrial enlargement. 16,17 Moreover, cardiac MRI is superior to echocardiography on d...

BackgroundHepatitis D virus (HDV) infection is considered to cause more severe hepatitis than hepatitis B virus (HBV) monoinfection. With more than 9.5 million HBV-infected people, Vietnam will face an enormous health burden. The prevalence of HDV in Vietnamese HBsAg-positive patients is speculative. Therefore, we assessed the prevalence of HDV in Vietnamese patients, determined the HDV-genotype distribution and compared the findings with the clinical outcome.Methods266 sera of well-characterized HBsAg-positive patients in Northern Vietnam were analysed for the presence of HDV using newly developed HDV-specific RT-PCRs. Sequencing and phylogenetic analysis were performed for HDV-genotyping.ResultsThe HDV-genome prevalence observed in the Vietnamese HBsAg-positive patients was high with 15.4% while patients with acute hepatitis showed 43.3%. Phylogenetic analysis demonstrated a predominance of HDV-genotype 1 clustering in an Asian clade while HDV-genotype 2 could be also detected. The serum aminotransferase levels (AST, ALT) as well as total and direct bilirubin were significantly elevated in HDV-positive individuals (p<0.05). HDV loads were mainly low (<300 to 4.108 HDV-copies/ml). Of note, higher HDV loads were mainly found in HBV-genotype mix samples in contrast to single HBV-infections. In HBV/HDV-coinfections, HBV loads were significantly higher in HBV-genotype C in comparison to HBV-genotype A samples (p<0.05).ConclusionHDV prevalence is high in Vietnamese individuals, especially in patients with acute hepatitis B. HDV replication activity showed a HBV-genotype dependency and could be associated with elevated liver parameters. Besides serological assays molecular tests are recommended for diagnosis of HDV. Finally, the high prevalence of HBV and HDV prompts the urgent need for HBV-vaccination coverage.