PSLS at rest was significantly lower in patients with left main or three-vessel CAD without RWMA, and might be useful for identifying patients with a severe CAD.

Abstract-Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarctions or may lead to insidious progressive brain damage resulting in vascular dementia. This study was designed to evaluate the prevalence and risk factors of SCI in an apparently normal adult population. Nine hundred ninety-four consecutive symptom-free adults (mean age 49.0Ϯ7.7; men:women 830:164) who underwent brain magnetic resonance imaging at the Center for Health Promotion at Samsung Medical Center were assessed. All were neurologically normal in history and physical examination. A total of 121 SCI lesions was observed in 58 subjects. The lesion prevalence adjusted for patient age was 5.1%. There was no gender difference in prevalence. Ninety-nine lesions were Ͻ1 cm in diameter, 15 were between 1 and 2 cm, 3 were between 2 and 3 cm, and 4 were Ͼ3 cm in diameter. The most frequent site of the SCI lesion was basal ganglia, after which the periventricular white matter, cerebral cortex, and thalamus were the most frequent sites. Old age, hypertension, a history of coronary artery disease, evidence of cardiomegaly in chest radiographs, and high fasting glucose/hemoglobin A1c levels were associated with SCI on univariate analysis. Multivariate analysis demonstrated old age and hypertension to be independent risk factors for SCI, and mild alcohol consumption was revealed as an independent protective factor against SCI. Key Words: cerebral infarction Ⅲ risk factors Ⅲ hypertension, essential Ⅲ elderly Ⅲ alcohol S ilent cerebral infarction (SCI) is defined as a brain lesion that is presumably a result of vascular occlusion found incidentally by magnetic resonance imaging (MRI) or computed tomography (CT) in otherwise healthy subjects or during autopsy. [1][2][3] It is considered a precursor of symptomatic stroke and progressive brain damage 1-3 that may be associated with vascular dementia.The reported prevalence of SCI has been varied, depending on the study subjects. In studies dealing with symptomatic stroke patients, that prevalence ranged from 10% to 38%. 4,5 A prevalence of 13% was reported in a small population study of normal subjects, 6 and in a study on a large number of elderly subjects, the prevalence was 33% in patients Ն65 years. 7 Because such variance in study subjects has led to different conclusions in regard to the prevalence and risk factors of SCI, 8 -10 we attempted to present a more comprehensive study of SCI in a relatively large population of apparently normal adults of all ages. Methods SubjectsWe studied 994 healthy consecutive subjects who visited the Center for Health Promotion at Samsung Medical Center, Seoul, Korea, from September 1994 through October 1996 and who underwent MRI of the brain as part of their routine health check. Their age ranged from 20 to 78 years; 54 subjects were Ͻ40 years, 572 subjects were between 40 and 49 years, 271 subjects were between 50 and 59 years, 81 subjects were between 60 and 69 years, and 16 subj...

Background: Although takotsubo cardiomyopathy (TTC) typically affects the apical and/or midventricular segments, several recent cases have reported a reverse or inverted variant of TTC. The aim of this study was to investigate the clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings in patients presenting as inverted TTC and compare those parameters to those presenting as mid or apical variant. Hypothesis: The clinical features of inverted TTC are different from those of other types of TTC. Methods: Of 103 patients enrolled from the TTC registry database, 20 showed inverted TTC (inverted TTC group), and 83 showed mid or apical variant (other TTC group). Results: Clinical presentations and in-hospital courses were mostly similar between the groups. However, the inverted TTC group was younger (median, 54.5 vs 64.0 years; P = 0.006) than other TTC and had a higher prevalence of triggering stress (100% vs 77%, P = 0.018), whereas other TTC group had higher prevalence of dyspnea (58% vs 30%, P = 0.025), pulmonary edema (46% vs 20%, P = 0.035), cardiogenic shock (36% vs 10%, P = 0.023), T-wave inversion (81% vs 60%, P = 0.049), and significant reversible mitral regurgitation (MR) (19% vs 0%, P = 0.033). Also, the inverted TTC group had significantly higher creatine kinase MB fraction (CK-MB); CK-MB (median, 30.7 vs 7.6 ng/mL; P = 0.001) and troponin-I (median, 13.1 vs 1.6 ng/mL; P = 0.001), but lower N-terminalpro-brain natriuretic peptide (NT-proBNP) levels (median, 613.3 vs 4987.0 pg/mL; P = 0.020). Conclusions: Inverted TTC presents at a younger age and has a higher prevalence of triggering stress, whereas other TTC has a higher prevalence of heart failure symptoms, significant reversible MR, and T-wave inversion and higher NT-proBNP levels despite other clinical features that are mostly similar.