Schizophrenia is a severe psychiatric disorder with a strong genetic predisposition. Structural and functional brain deficits throughout the cerebral cortex, particularly in the language-processing associated brain regions, are consistently reported. Recently, increasing evidence from magnetic resonance imaging (MRI) studies suggests that healthy relatives of schizophrenic patients also show structural brain abnormalities in cortical gray matter (GM) volume, and thickness, suggesting that this may be associated with an unexpressed genetic liability for the disorder. Unfortunately, the findings are not consistent, which may be caused by different age ranges of the cohorts studied. In the present study, we examined the voxel-based whole brain cortical thickness, area, GM volume densities, and regional cortical thickness-related laterality indices in 14 bilateral ROIs from known language-processing circuits, in 20 schizophrenia patients, 21 young non-psychotic subjects with heightened genetic risk for schizophrenia at the peak ages for development of the disorder, and 48 matched controls. The results showed widespread significant reductions in cortical thickness, cortical GM volume density, and scattered decreases in cortical surface area in the schizophrenia patients compared with those in the high-risk subjects and normal controls. Moreover, the genetic high-risk subjects showed significantly increased regional cortical thickness in 7 of the 14 ROIs in the language-processing pathway when compared with controls. They also had increased GM volume density in scattered regions associated with language-processing when compared with the normal controls. Laterality analyses showed that the spatial distribution of abnormal cortical thickness in the schizophrenia patients as well as in the high-risk subjects, contributed to a decrease of the normal left-greater-than-right anatomical asymmetry in inferior orbital frontal area, and a increased left-greater-than-right pattern in the inferior parietal and occipital regions. Together with the existing findings from literature, the results of the present study suggest that developmental disruption of the anatomical differentiation of the hemispheres provides a basis for understanding the language impairment and symptoms of psychosis, and that these may arise because of abnormal left-right hemispheric communications that interrupt the normal flow of information processing. The early structural deficits in language-processing circuits may precede the appearance of symptoms and can indicate increased risk of developing schizophrenia.
Background
Although admission heart rate predicts higher mortality after acute myocardial infarction (
AMI
), less is known about discharge heart rate. We tested the hypothesis that higher discharge heart rate after
AMI
is related to increased long‐term mortality independent of admission heart rate, and assessed whether β blockers modify this relationship.
Methods and Results
In 2 prospective US multicenter registries of
AMI
, we evaluated the associations of discharge and admission heart rate with 3‐year mortality using Cox models. Among 6576 patients with
AMI
, discharge heart rate was modestly associated with initial heart rate (
r
=0.28), comorbidities, and infarct severity. In this cohort, 10.7% did not receive β blockers at discharge. After full adjustment for demographic, psychosocial, and clinical covariates, discharge heart rate (hazard ratio [HR]=1.14 per 10 beats per minute [bpm]; 95%
CI
=1.07–1.21 per 10 bpm) was more strongly associated with risk of death than admission heart rate (HR=1.05 per 10 bpm; 95% CI=1.02–1.09 per 10 bpm) when both were entered in the same model (
P
=0.043 for comparison). There was a significant interaction between discharge heart rate and β‐blocker use (
P
=0.004) on mortality, wherein risk of death was markedly higher among those with high discharge heart rate and not on β blockers (HR=1.35 per 10 bpm; 95% CI=1.19–1.53 per 10 bpm) versus those with a high discharge heart rate and on β blockers at discharge (HR=1.10 per 10 bpm; 95% CI=1.03–1.17 per 10 bpm).
Conclusions
Higher discharge heart rate after
AMI
was more strongly associated with 3‐year mortality than admission heart rate, and the risk associated with higher discharge heart rate was modified by β blockers at discharge. These findings highlight opportunities for risk stratification and intervention that will require further investigation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.