Adrenal vein sampling is safe; increasing the selectivity index cutoffs lowers the number of usable adrenal vein samplings; higher lateralization index cutoff values lead to missing a proportion of aldosterone-producing adenomas. The improved selectivity rate provided by adrenocorticotropic hormone stimulation should be weighed against the loss of correct lateralization.

Background This study assessed the prevalence of left ventricular ( LV ) involvement and characterized the clinical, electrocardiographic, and imaging features of LV phenotype in patients with arrhythmogenic right ventricular cardiomyopathy ( ARVC ). Differential diagnosis between ARVC ‐ LV phenotype and dilated cardiomyopathy ( DCM ) was evaluated. Methods and Results The study population included 87 ARVC patients (median age 34 years) and 153 DCM patients (median age 51 years). All underwent cardiac magnetic resonance with quantitative tissue characterization. Fifty‐eight ARVC patients (67%) had LV involvement, with both LV systolic dysfunction and LV late gadolinium enhancement ( LGE ) in 41/58 (71%) and LV ‐ LGE in isolation in 17 (29%). Compared with DCM , the ARVC ‐ LV phenotype was statistically significantly more often characterized by low QRS voltages in limb leads, T‐wave inversion in the inferolateral leads and major ventricular arrhythmias. LV ‐ LGE was found in all ARVC patients with LV systolic dysfunction and in 69/153 (45%) of DCM patients. Patients with ARVC and LV systolic dysfunction had a greater amount of LV ‐ LGE (25% versus 13% of LV mass; P <0.01), mostly localized in the subepicardial LV wall layers. An LV ‐ LGE ≥20% had a 100% specificity for diagnosis of ARVC ‐ LV phenotype. An inverse correlation between LV ejection fraction and LV ‐ LGE extent was found in the ARVC ‐ LV phenotype ( r =−0.63; P <0.01), but not in DCM ( r =−0.01; P =0.94). Conclusions LV involvement in ARVC is common and characterized by clinical and cardiac magnetic resonance features which differ from those seen in DCM . The most distinctive feature of ARVC ‐ LV phenotype is the large amount of LV ‐ LGE /fibrosis, which impacts directly and negatively on the LV systolic function.

Research in both humans and monkeys has shown that even simple hand movements require cortical control beyond primary sensorimotor areas. An extensive functional neuroimaging literature demonstrates the key role that cortical fronto-parietal regions play for movements such as reaching and reach-to-grasp. However, no study so far has examined the specific white matter connections linking the fronto-parietal regions, namely the 3 parallel pathways of the superior longitudinal fasciculus (SLF). The aim of the current study was to explore how selective fronto-parietal connections are for different kinds of hand movement in 30 right-handed subjects by correlating diffusion imaging tractography and kinematic data. We showed that a common network, consisting of bilateral SLF II and SLF III, was involved in both reaching and reach-to-grasp movements. Larger SLF II and SLF III in the right hemisphere were associated with faster speed of visuomotor processing, while the left SLF II and SLF III played a role in the initial movement trajectory control. Furthermore, the right SLF II was involved in the closing grip phase necessary for efficient grasping of the object. We demonstrated for the first time that individual differences in asymmetry and structure of the fronto-parietal networks were associated with visuomotor processing in humans.

Abstract-Adrenal vein sampling is the gold standard for identification of surgically curable primary aldosteronism, but its accuracy might be hindered by blood dilution from accessory vein blood. We prospectively investigated the presence of accessory veins draining into adrenal veins and their effect on the selectivity index (SI) Key Words: adrenal vein sampling Ⅲ aldosterone Ⅲ aldosteronism Ⅲ adrenocorticophic hormone Ⅲ catheterization P rimary aldosteronism (PA), the most common endocrine cause of curable arterial hypertension, 1 is usually attributed to aldosterone-producing adenoma (APA) and, less commonly, to unilateral 2 or bilateral adrenal hyperplasia. 3 The former two conditions are characterized by lateralized aldosterone secretion and are best treated by adrenalectomy, whereas the latter, featuring bilateral aldosterone excess, requires lifelong antihypertensive therapy on the basis of mineralocorticoid receptor antagonists.Discrimination between unilateral aldosterone excess and bilateral adrenal hyperplasia is feasible with NP59 scintigraphy or adrenal vein sampling (AVS). Because NP59 has a low sensitivity and is not generally available, 3,4 AVS is currently considered the gold diagnostic standard for identifying the surgically curable forms of PA. 5,6 However, interpretation of AVS results requires attention to several issues and particularly to the criteria to be used for assessing selectivity and establishing the lateralization of aldosterone excess. 7,8 With regard to selectivity, experience has shown that selective catheterization can be consistently achieved on the left side, whereas on the right side the success rate is lower. 7 The difficulty of selectively cannulating the right adrenal vein, is due to its brevity and direct draining in the inferior vena cava (IVC), while the training and experience of the operator do not seem to fully account for this lower success rate. 3,7 Because, on the right side, the adrenal vein often shares egress in the IVC with accessory hepatic veins, we hypothesized that the dilution of adrenal vein blood with blood draining from the liver, which carries a low cortisol concentration, might account for the lower success rate of catheterization on this side. However, there was no information on how common accessory hepatic veins are and on their impact on the selectivity of an AVS index. Therefore, this study was designed to prospectively investigate these questions. Patients and MethodsThe patients to be submitted to AVS were selected among those with a diagnosis of PA, as described previously, 1 who had no contraindications to general anesthesia and surgery. They were asked to sign a written consent to undergo not only AVS but also laparoscopic adrenalectomy in case a lateralized aldosterone secretion was eventually identified. 3,9

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