The purpose of this study is to assess the relationship between left atrial (LA) size and outcome after acute myocardial infarction (AMI) in patients undergoing primary percutaneous coronary intervention (PCI) and to evaluate dynamic changes in LA size during long-term follow-up. Echocardiographic analyses were performed on 253 AMI patients (174 male and 79 female, 65.4 ± 13.7 yr) undergoing PCI. These subjects were studied at baseline and at 12 months. Clinical follow-up were done at 30.8 ± 7.5 months. We assessed LA volume index (LAVI) at AMI-onset and at 12-month. Change of LAVI was an independent predictor of new onset of atrial fibrillation or hospitalization for heart failure (P = 0.002). Subjects who survived the 12-month period displayed an increased LAVI mean of 1.86 ± 4.01 mL/m2 (from 26.1 ± 8.6 to 28.0 ± 10.1 mL/m2, P < 0.001). The subject group that displayed an increased LAVI correlated with a low left ventricular ejection fraction, large left ventricle systolic and diastolic dimensions and an enlarged LA size. In conclusion, change of LAVI is useful parameter to predict subsequent adverse cardiac event in AMI patients. Post-AMI echocardiographic evaluation of LAVI provides important prognostic information that is significantly greater than that obtained from clinical and laboratory parameters alone.

The transradial approach for coronary angiography (CAG) is known to be associated with fewer vascular complications and shorter hospital stay than the transfemoral approach. In the transradial approach, the insertion of a guiding catheter can be affected by the shape and vascular tortuosity of the brachiocephalic and subclavian arteries. In this study, we compared the left transradial with the right transradial approach in elderly patients. From 1 July 2008 to 30 April 2009, we performed CAG and angioplasty in 143 cases via the left transradial approach (Group I) and in 219 cases via the right approach (Group II). Among elderly patients over the age of 65 years, Group I consisted of 63 cases (71.8±5.17 years, male: 55.6%) and Group II consisted of 97 cases (72.7±5.16 years, male: 52.6%). We evaluated the degree of axillary tortuosity, the angle of the aorta to the subclavian artery, the procedural success rate, the fluoroscopic times, the size of the radial artery, and the procedure-related complications of both groups. The degree of axillary artery tortuosity and the angle of the aorta to the subclavian artery increased with age. In elderly patients, the degree of axillary tortuosity in Group I tended to be less severe than that in Group II (good: 82% vs 67.7%, mild: 11.5% vs 17.2%, moderate: 3.3% vs 8.6%, severe: 3.3% vs 6.5%, p=0.059), and the angle of the aorta to the subclavian artery was smaller in Group I (small: 95.1% vs 83.9%, moderate: 3.3% vs. 5.4%, severe: 1.6% vs 10.8%, p=0.024). There was no statistical difference in the procedural success rate (96.8% vs. 89.7%, p=0.094), but the fluoroscopy time was significantly shorter in Group I (Group I: 46.8±26.4 sec, Group II: 58.2±36.6 sec, p=0.037). In elderly patients, the angle of the aorta to the subclavian artery was smaller and the fluoroscopy time was shorter via the left transradial approach compared with the right approach. We conclude that the left transradial approach is more effective and acceptable for elderly patients than the right approach.

No abstract

Accurate radiation therapy (RT) targeting is crucial for glioblastoma treatment but may be challenging using clinical imaging alone due to the infiltrative nature of glioblastomas. Precise targeting by whole-brain spectroscopic MRI, which maps tumor metabolites including choline (Cho) and N-acetylaspartate (NAA), can quantify early treatment-induced molecular changes that other traditional modalities cannot measure. We developed a pipeline to determine how spectroscopic MRI changes during early RT are associated with patient outcomes to provide insight into the utility of adaptive RT planning. Data were obtained from a study (NCT03137888) where glioblastoma patients received high-dose RT guided by the pre-RT Cho/NAA twice normal (Cho/NAA ≥ 2x) volume, and received spectroscopic MRI scans pre- and mid-RT. Overlap statistics between pre- and mid-RT scans were used to quantify metabolic activity changes after two weeks of RT. Log-rank tests were used to quantify the relationship between imaging metrics and patient overall and progression-free survival (OS/PFS). Patients with lower Jaccard/Dice coefficients had longer PFS (p = 0.045 for both), and patients with lower Jaccard/Dice coefficients had higher OS trending towards significance (p = 0.060 for both). Cho/NAA ≥ 2x volumes changed significantly during early RT, putting healthy tissue at risk of irradiation, and warranting further study into using adaptive RT planning.