Michael W. Fong

Value of Long-Term Administration of Acyclovir and Similar Agents for Protecting Against AIDS-Related Lymphoma: Case-Control and Historical Cohort Studies

Acyclovir or similar agents with activity against Epstein-Barr virus (EBV) theoretically may prevent non-Hodgkins lymphoma (NHL) in AIDS. A case-control study of 29 patients with AIDS-related NHL and 58 matched control subjects assessed the frequency with which daily acyclovir (>/=800 mg/d) or similar agents were used for > or =1 year. In a historical cohort of 304 patients with AIDS for > or =2 years, the prevalence of NHL was assessed among 3 groups of patients: those who received long-term treatment with high-dose acyclovir (or similar agents) or low-dose or intermittent acyclovir; those treated with ganciclovir/foscarnet for <1 year; and those who had not previously been treated with acyclovir, ganciclovir, or foscarnet. In the case-control study, 22 patients (72.4%) with NHL never received acyclovir or similar drugs versus 19 control subjects (32.8%; P=. 002); 2 patients (6.9%) with NHL received acyclovir (> or =800 mg/d) for > or =1 year versus 27 (46.6%) of control subjects (P=.0001). In the cohort study, 6 (6.8%) of 88 patients who received acyclovir (> or =800 mg/d) for > or =1 year developed NHL versus 15 (15.5%) of 97 patients who received intermittent or lower-dose acyclovir and 30 (25.2%) of 119 patients who never received these agents (P=.002). Long-term administration (>1 year) of high-dose acyclovir or similar agents with anti-EBV activity may prevent NHL in patients with AIDS. A prospective, randomized study is warranted to confirm these results.

Characteristics and management of patients presenting to the emergency department with hypertensive urgency

Few studies have examined the characteristics of patients presenting with hypertensive urgency, factors contributing to their presentation, or their management. The time and cost associated with treatment are unknown. Retrospective analysis of 50 emergency department patients with hypertensive urgency (symptomatic blood pressure (BP) elevation focusing on systolic BP >180 mm Hg or diastolic BP >110 mm Hg) was performed. The hospital database was queried to determine the cost of the average treat‐and‐release visit. The mean age was 54.3±15.6 years; 64% were female; 46% were black; 90% had diagnosed hypertension. The mean presenting BP was 198±27.6/109±17.3 mm Hg; 66% had systolic BP >180 mm Hg, and 38% had diastolic BP >110 mm Hg. Initially, 30% were not on antihypertensives, and 28% were on monotherapy. Headache (42%) and dizziness (30%) were most frequently reported symptoms. Presentation was most often attributed to running out of medication (16%). IV and oral labetalol were given to 28% and 24% of patients, respectively. Fifty‐six percent of patients had no change in baseline therapy at discharge. The average emergency department stay was 5 hours 17 minutes ± 4 hours 27 minutes. The average cost for similar visits in 2004 was

Cardiac Imaging: Part 1, MR Pulse Sequences, Imaging Planes, and Basic Anatomy

1543 per visit. Emergency department visits for hypertensive urgency are related mostly to noncompliance. Labetalol was the most frequently used therapy. Management in the primary care office could result in substantial cost savings.

Noninvasive iphone Measurement of Left Ventricular Ejection Fraction Using Intrinsic Frequency Methodology

OBJECTIVE MRI is a well-established modality for evaluating congenital and acquired cardiac diseases. This article reviews the latest pulse sequences used for cardiac MRI. In addition, the standard cardiac imaging planes and corresponding anatomy are described and illustrated. CONCLUSION Familiarity with the basic pulse sequences, imaging planes, and anatomy pertaining to cardiac MRI is essential to formulate optimal protocols and interpretations.

Treatment of ventricular tachycardia in patients with heart failure.

Objective: The study is based on previously reported mathematical analysis of arterial waveform that extracts hidden oscillations in the waveform that we called intrinsic frequencies. The goal of this clinical study was to compare the accuracy of left ventricular ejection fraction derived from intrinsic frequencies noninvasively versus left ventricular ejection fraction obtained with cardiac MRI, the most accurate method for left ventricular ejection fraction measurement. Design: After informed consent, in one visit, subjects underwent cardiac MRI examination and noninvasive capture of a carotid waveform using an iPhone camera (The waveform is captured using a custom app that constructs the waveform from skin displacement images during the cardiac cycle.). The waveform was analyzed using intrinsic frequency algorithm. Setting: Outpatient MRI facility. Subjects: Adults able to undergo MRI were referred by local physicians or self-referred in response to local advertisement and included patients with heart failure with reduced ejection fraction diagnosed by a cardiologist. Interventions: Standard cardiac MRI sequences were used, with periodic breath holding for image stabilization. To minimize motion artifact, the iPhone camera was held in a cradle over the carotid artery during iPhone measurements. Measurements and Main Results: Regardless of neck morphology, carotid waveforms were captured in all subjects, within seconds to minutes. Seventy-two patients were studied, ranging in age from 20 to 92 years old. The main endpoint of analysis was left ventricular ejection fraction; overall, the correlation between ejection fraction–iPhone and ejection fraction–MRI was 0.74 (r = 0.74; p < 0.0001; ejection fraction–MRI = 0.93 × [ejection fraction–iPhone] + 1.9). Conclusions: Analysis of carotid waveforms using intrinsic frequency methods can be used to document left ventricular ejection fraction with accuracy comparable with that of MRI. The measurements require no training to perform or interpret, no calibration, and can be repeated at the bedside to generate almost continuous analysis of left ventricular ejection fraction without arterial cannulation.

Hypertrophic cardiomyopathy with features of left ventricular non-compaction: How many diseases?

Heart failure is a major public health concern that is frequently complicated by ventricular arrhythmias. Sustained ventricular tachycardia is associated with an increased risk for progressive heart failure and sudden death. We summarize the current management strategies for ventricular tachycardia in heart failure patients, including implantable cardioverter-defibrillator therapy, pharmacologic therapy, catheter ablation techniques, ventricular assist device therapy, and heart transplantation.

Renal Denervation in Heart Failure

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Assessment of segmental myocardial blood flow and myocardial perfusion reserve by adenosine-stress myocardial arterial spin labeling perfusion imaging.

Heart failure has emerged as one of the most important diseases of the past century. The understanding and treatment of heart failure has evolved significantly over the years. As we move further into the era of device therapy, attention has turned to the idea of sympathetic nervous system modulation through renal denervation to treat heart failure. In this review, we summarize the background research, denervation technique, and current studies on renal denervation for the treatment of heart failure. We also compare and contrast the work on carotid barostimulation.

Double-gated myocardial ASL perfusion imaging is robust to heart rate variation

To determine the feasibility of measuring increases in myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) on a per‐segment basis using arterial spin labeled (ASL) magnetic resonance imaging (MRI) with adenosine vasodilator stress in normal human myocardium.

Cardiac Arteriovenous Malformation

Cardiac motion is a dominant source of physiological noise (PN) in myocardial arterial spin labeled (ASL) perfusion imaging. This study investigates the sensitivity to heart rate variation (HRV) of double‐gated myocardial ASL compared with the more widely used single‐gated method.