An American HeartAssociation/American Stroke Association Journal

February 2017Volume 48Number 2

EDITORIALSPrehospital Scales for Large Vessel Occlusion: Closing in on a Moving Target 247Patrik Michel, MD

Sex Is Not a Risk Factor in Outcome When a Stroke Unit Treats the Patient 250Valeria Caso, MD, PhD; Maurizio Paciaroni, MD

Stroke: Highlights of Selected Articles 252

ORIGINAL CONTRIBUTIONSClinical SciencesGenetic Predisposition to Ischemic Stroke: A Polygenic Risk Score 253Tsuyoshi Hachiya, PhD; Yoichiro Kamatani, MD; Atsushi Takahashi, PhD; Jun Hata, MD; Ryohei Furukawa, PhD; Yuh Shiwa, PhD; Taiki Yamaji, MD; Megumi Hara, MD; Kozo Tanno, MD; Hideki Ohmomo, PhD; Kanako Ono, BSc; Naoyuki Takashima, MD; Koichi Matsuda, MD; Kenji Wakai, MD; Norie Sawada, MD; Motoki Iwasaki, MD; Kazumasa Yamagishi, MD; Tetsuro Ago, MD; Toshiharu Ninomiya, MD; Akimune Fukushima, MD; Atsushi Hozawa, MD; Naoko Minegishi, MD; Mamoru Satoh, MD; Ryujin Endo, MD; Makoto Sasaki, MD; Kiyomi Sakata, MD; Seiichiro Kobayashi, MD; Kuniaki Ogasawara, MD; Motoyuki Nakamura, MD; Jiro Hitomi, MD; Yoshikuni Kita, PhD; Keitaro Tanaka, MD; Hiroyasu Iso, MD; Takanari Kitazono, MD; Michiaki Kubo, MD; Hideo Tanaka, MD; Shoichiro Tsugane, MD; Yutaka Kiyohara, MD; Masayuki Yamamoto, MD; Kenji Sobue, MD; Atsushi Shimizu, PhD

Adherence to a Healthy Nordic Diet and Risk of Stroke: A Danish Cohort Study 259Camilla Plambeck Hansen, PhD; Kim Overvad, MD, PhD; Cecilie Kyrø, PhD; Anja Olsen, PhD; Anne Tjønneland, MD, DMSc; Søren Paaske Johnsen, MD, PhD; Marianne Uhre Jakobsen, PhD; Christina Catherine Dahm, PhD

Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men

265

Daniel Falkstedt, PhD; Valerie Wolff, MD, PhD; Peter Allebeck, MD, PhD; Tomas Hemmingsson, PhD; Anna-Karin Danielsson, PhD

Age–Period–Cohort Analysis of Stroke Mortality in China: Data From the Global Burden of Disease Study 2013

271

Zhenkun Wang, MMed; Songbo Hu, PhD; Shuping Sang, PhD; Lisha Luo, BM; Chuanhua Yu, PhD

Strokes Associated With Pregnancy and Puerperium: A Nationwide Study by the Japan Stroke Society

276

Kazumichi Yoshida, MD, PhD; Jun C. Takahashi, MD, PhD; Yohei Takenobu, MD, PhD; Norihiro Suzuki, MD, PhD; Akira Ogawa, MD, PhD; Susumu Miyamoto, MD, PhD

Predictors and Clinical Impact of Incident Lacunes in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

283

Yifeng Ling, MD; François De Guio, PhD; Marco Duering, MD; Eric Jouvent, MD; Dominique Hervé, MD; Ophélia Godin, PhD; Martin Dichgans, MD; Hugues Chabriat, MD

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Stroke

On the Cover: The image is taken from an article in this issue, “New Insight Into the Pathogenesis of Cerebral Small-Vessel Diseases” by Müller et al (Stroke. 2017;48:520–527. doi: 10.1161/STROKEAHA.116.012888). The image is Figure 1A and 1C.

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Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

290

Jan F. Scheitz, MD; Azmil H. Abdul-Rahim, MBChB, Msc(StrokeMed); Rachael L. MacIsaac, PhD; Charith Cooray, MD; Heidi Sucharew, PhD; Dawn Kleindorfer, MD; Pooja Khatri, MD, MSc; Joseph P. Broderick, MD; Heinrich J. Audebert, MD; Niaz Ahmed, MD, PhD; Nils Wahlgren, MD, PhD; Matthias Endres, MD; Christian H. Nolte, MD; Kennedy R. Lees, MD, FRCP; on behalf of SITS Scientific Committee

Field Validation of the Los Angeles Motor Scale as a Tool for Paramedic Assessment of Stroke Severity

298

Joon-Tae Kim, MD; Pil-Wook Chung, MD; Sidney Starkman, MD; Nerses Sanossian, MD; Samuel J. Stratton, MD; Marc Eckstein, MD, MPH; Frank D. Pratt, MD, MPHTM; Robin Conwit, MD; David S. Liebeskind, MD; Latisha Sharma, MD; Lucas Restrepo, MD; May-Kim Tenser, MD; Miguel Valdes-Sueiras, MD; Jeffrey Gornbein, PhD; Scott Hamilton, PhD; Jeffrey L. Saver, MD; on behalf of the FAST-MAG Trial (Field Administration of Stroke Therapy–Magnesium) Nurse-Coordinators and Investigators

Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya

307

Holger Wenz, MD; Ralf Wenz, MSc; Máté Maros, MD; Gregory Ehrlich, MD; Mansour Al-Zghloul, MD; Christoph Groden, MD; Alex Förster, MD

Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation

314

Johanna Pennlert, MD; Rosanna Overholser, PhD; Kjell Asplund, MD, PhD; Bo Carlberg, MD, PhD; Bart Van Rompaye, PhD; Per-Gunnar Wiklund, MD, PhD; Marie Eriksson, PhD

Venous Thrombotic Recurrence After Cerebral Venous Thrombosis: A Long-Term Follow-Up Study

321

Paola Palazzo, MD, PhD; Pierre Agius, MD; Pierre Ingrand, MD; Jonathan Ciron, MD; Matthias Lamy, MD; Aline Berthomet, MD; Paul Cantagrel, MS; Jean-Philippe Neau, MD

Renal Dysfunction Is Associated With Poststroke Discharge Disposition and In-Hospital Mortality: Findings From Get With The Guidelines–Stroke

327

Nada El Husseini, MD, MHSc; Gregg C. Fonarow, MD; Eric E. Smith, MD, MPH; Christine Ju, MS; Lee H. Schwamm, MD; Adrian F. Hernandez, MD, MHS; Phillip J. Schulte, PhD; Ying Xian, MD, PhD; Larry B. Goldstein, MD

NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study): Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population

335

Aliona Nacu, MD; Christopher E. Kvistad, MD, PhD; Halvor Naess, MD, PhD; Halvor Øygarden, MD, PhD; Nicola Logallo, MD, PhD; Jörg Assmus, PhD; Ulrike Waje-Andreassen, MD, PhD; Kathinka D. Kurz, MD, PhD; Gesche Neckelmann, MD; Lars Thomassen, MD, PhD

Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy

342

María Hernández-Pérez, MD; Daniel Bos, MD, PhD; Laura Dorado, MD, PhD; Karlijn Pellikaan, BSc; Meike W. Vernooij, MD, PhD; Elena López-Cancio, MD, PhD; Natalia Pérez de la Ossa, MD, PhD; Meritxell Gomis, MD, PhD; Carlos Castaño, MD; Josep Munuera, MD, PhD; Josep Puig, MD, PhD; Mònica Millán, MD, PhD; Antoni Dávalos, MD, PhD

Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

348

Pierre Seners, MD; Robert Hurford, MSc; Marie Tisserand, PhD; Guillaume Turc, PhD; Laurence Legrand, MD; Olivier Naggara, PhD; Jean-Louis Mas, MD; Catherine Oppenheim, PhD; Jean-Claude Baron, ScD

Arterial Obstruction on Computed Tomographic or Magnetic Resonance Angiography and Response to Intravenous Thrombolytics in Ischemic Stroke

353

Grant Mair, MBChB; Rüdiger von Kummer, Prof Dr med; Alessandro Adami, MD; Philip M. White, MD; Matthew E. Adams, MBBChir; Bernard Yan, MD; Andrew M. Demchuk, MD; Andrew J. Farrall, MD; Robin J. Sellar, MBBS; Eleni Sakka, MSc; Jeb Palmer; David Perry, BSc; Richard I. Lindley, MD; Peter A.G. Sandercock, DM; Joanna M. Wardlaw, MD; for the IST-3 Collaborative Group

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Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke

361

Kimon Bekelis, MD; Symeon Missios, MD; Todd A. MacKenzie, PhD; Stavropoula Tjoumakaris, MD; Pascal Jabbour, MD

Sex and Stroke in Thrombolyzed Patients and Controls 367Christian Hametner, MD, MSc; Rachael L. MacIsaac, PhD; Lars Kellert, MD; Azmil H. Abdul-Rahim, MBChB, MRCP; Peter A. Ringleb, MD; Kennedy R. Lees, MD; for the VISTA Collaborators

Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different

375

Sònia Abilleira, MD, PhD; Aida Ribera, BSc, PhD; Pedro Cardona, MD; Marta Rubiera, MD, PhD; Elena López-Cancio, MD, PhD; Sergi Amaro, MD, PhD; Ana Rodríguez-Campello, MD; Pol Camps-Renom, MD; David Cánovas, MD, PhD; Maria Angels de Miquel, MD, PhD; Alejandro Tomasello, MD; Sebastian Remollo, MD; Antonio López-Rueda, MD; Elio Vivas, MD; Joan Perendreu, MD, PhD; Miquel Gallofré, MD, PhD

Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke: Results From the SWIFT-PRIME Trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

379

Theresa I. Shireman, PhD; Kaijun Wang, PhD; Jeffrey L. Saver, MD; Mayank Goyal, MD; Alain Bonafé, MD; Hans-Christoph Diener, MD, PhD; Elad I. Levy, MD; Vitor M. Pereira, MD; Gregory W. Albers, MD; Christophe Cognard, MD; Werner Hacke, MD, PhD; Olav Jansen, MD, PhD; Tudor G. Jovin, MD; Heinrich P. Mattle, MD; Raul G. Nogueira, MD; Adnan H. Siddiqui, MD, PhD; Dileep R. Yavagal, MD; Thomas G. Devlin, MD, PhD; Demetrius K. Lopes, MD; Vivek K. Reddy, MD; Richard du Mesnil de Rochemont, MD; Reza Jahan, MD; Katherine A. Vilain, MPH; John House, MPH; Jin-Moo Lee, MD; David J. Cohen, MD, MSc; on behalf of the  SWIFT-PRIME Investigators

Pioglitazone for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis 388Meng Lee, MD; Jeffrey L. Saver, MD; Hung-Wei Liao, MD; Chun-Hsien Lin, MD; Bruce Ovbiagele, MD

Symptomatic Carotid Occlusion Is Frequently Associated With Microembolization 394Ava L. Liberman, MD; Ali Zandieh, MD, MPH; Caitlin Loomis, MD; Jonathan M. Raser-Schramm, MD, PhD; Christina A. Wilson, MD, PhD; Jose Torres, MD; Koto Ishida, MD; Swaroop Pawar, MD; Rebecca Davis, MD; Michael T. Mullen, MD, MS; Steven R. Messé, MD; Scott E. Kasner, MD, MS; Brett L. Cucchiara, MD

AMOBES (Active Mobility Very Early After Stroke): A Randomized Controlled Trial 400Alain P. Yelnik, MD; Victorine Quintaine, MD; Cedric Andriantsifanetra, MD; Marie Wannepain, PT; Peggy Reiner, MD; Hélène Marnef, PT; Mathilde Evrard, PT; Elena Meseguer, MD; Jean Pascal Devailly, MD; Monica Lozano, PT; Catherine Lamy, MD; Florence Colle, MD; Eric Vicaut, MD, PhD; on behalf of the AMOBES Group

Predicting Home and Community Walking Activity Poststroke 406George D. Fulk, PhD; Ying He, PhD; Pierce Boyne, DPT; Kari Dunning, PhD

Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization

412

Shumei Man, MD, PhD; Margueritte Cox, MS, MGIST; Puja Patel, MS; Eric E. Smith, MD, MPH; Mathew J. Reeves, PhD; Jeffrey L. Saver, MD; Deepak L. Bhatt, MD, MPH; Ying Xian, MD, PhD; Lee H. Schwamm, MD; Gregg C. Fonarow, MD

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke: An Observational Study From the US Nationwide Inpatient Sample

420

Benjamin P. George, MD, MPH; Adam G. Kelly, MD; George P. Albert; David Y. Hwang, MD; Robert G. Holloway, MD, MPH

Basic SciencesHuman Muse Cells Reconstruct Neuronal Circuitry in Subacute Lacunar Stroke Model 428Hiroki Uchida, MD; Kuniyasu Niizuma, MD; Yoshihiro Kushida, PhD; Shohei Wakao, PhD; Teiji Tominaga, MD; Cesario V. Borlongan, PhD; Mari Dezawa, MD, PhD

Cystatin C Is a Crucial Endogenous Protective Determinant Against Stroke 436Zongping Fang, MD, PhD; Jiao Deng, MD, PhD; Zhixin Wu, MD; Beibei Dong, MD; Shiquan Wang, MD; Xiaodan Chen, MD; Huang Nie, MD, PhD; Hailong Dong, MD, PhD; Lize Xiong, MD, PhD

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12/15-Lipoxygenase Inhibition or Knockout Reduces Warfarin-Associated Hemorrhagic Transformation After Experimental Stroke

445

Yu Liu, MD, PhD; Yi Zheng, PhD; Hulya Karatas, MD, PhD; Xiaoying Wang, MD, PhD; Christian Foerch, MD; Eng H. Lo, PhD; Klaus van Leyen, PhD

Valproate Reduces Delayed Brain Injury in a Rat Model of Subarachnoid Hemorrhage 452Arend M. Hamming, MD; Annette van der Toorn, PhD; Umesh S. Rudrapatna, PhD; Lisha Ma, MD; Hine J.A. van Os, MSc; Michel D. Ferrari, MD, PhD; Arn M.J.M. van den Maagdenberg, PhD; Erik van Zwet, PhD; Katherine Poinsatte, BA; Ann M. Stowe, PhD; Rick M. Dijkhuizen, PhD; Marieke J.H. Wermer, MD, PhD

ABCA1/ApoE/HDL Pathway Mediates GW3965-Induced Neurorestoration After Stroke 459Xu Cui, MD, PhD; Michael Chopp, PhD; Zhenggang Zhang, MD, PhD; Rongwen Li, PhD; Alex Zacharek, MS; Julie Landschoot-Ward, BS; Poornima Venkat, PhD; Jieli Chen, MD

Neuroimaging Biomarkers Predict Brain Structural Connectivity Change in a Mouse Model of Vascular Cognitive Impairment

468

Philipp Boehm-Sturm, PhD; Martina Füchtemeier, PhD; Marco Foddis; Susanne Mueller; Rebecca C. Trueman, PhD; Marietta Zille, PhD; Jan Leo Rinnenthal, PhD; Theodore Kypraios, PhD; Laurence Shaw, PhD; Ulrich Dirnagl, MD; Tracy D. Farr, PhD

BRIEF REPORTSDischarge Disposition After Stroke in Patients With Liver Disease 476Neal S. Parikh, MD; Alexander E. Merkler, MD; Yecheskel Schneider, MD; Babak B. Navi, MD, MS; Hooman Kamel, MD

BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic

479

Sushanth Aroor, MBBS; Rajpreet Singh, MD; Larry B. Goldstein, MD

Three-Dimensional Map of Neonatal Arterial Ischemic Stroke Distribution From Early Multimodal Brain Imaging

482

Christian Stephan-Otto, PhD; Christian Núñez, PhD; Gemma Arca, PhD; Thais Agut, PhD; Alfredo García-Alix, PhD

Lacunar Infarcts and Intracerebral Hemorrhage Differences: A Nested Case–Control Analysis in the FHS (Framingham Heart Study)

486

Vasileios-Arsenios Lioutas, MD; Alexa Beiser, PhD; Jayandra Himali, PhD; Hugo Aparicio, MD; Jose Rafael Romero, MD; Charles DeCarli, MD; Sudha Seshadri, MD

Stroke as the Initial Manifestation of Atrial Fibrillation: The Framingham Heart Study 490Steven A. Lubitz, MD, MPH; Xiaoyan Yin, PhD; David D. McManus, MD, ScM; Lu-Chen Weng, PhD; Hugo J. Aparicio, MD, MPH; Allan J. Walkey, MD, PhD; Jose Rafael Romero, MD; Carlos S. Kase, MD; Patrick T. Ellinor, MD, PhD; Philip A. Wolf, MD; Sudha Seshadri, MD; Emelia J. Benjamin, MD, ScM

Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit 493Tzu-Ching Wu, MD; Stephanie A. Parker, RN; Amanda Jagolino, MD; Jose-Miguel Yamal, PhD; Ritvij Bowry, MD; Abraham Thomas, MD; Amy Yu, BA; James C. Grotta, MD

Splenectomy Does Not Improve Long-Term Outcome After Stroke 497Dannielle Zierath, BS; Angela Shen; Astiana Stults; Theresa Olmstead, BS; Kyra J. Becker, MD

COMMENTS AND OPINIONSPregnancy, Hormonal Treatments for Infertility, Contraception, and Menopause in Women After Ischemic Stroke: A Consensus Document

501

Valeria Caso, MD, PhD; Alberto Falorni, MD, PhD; Cheryl D. Bushnell, MD, MHS; Monica Acciarresi, MD; José Remohí, MD; Nikola Sprigg, MbCHB, DM; Sandro Gerli, MD

Poststroke Post-Traumatic Stress Disorder: A Review 507Andrew L.A. Garton, BS; Jonathan A. Sisti, BS; Vivek P. Gupta, BA; Brandon R. Cristophe, BA; E. Sander Connolly, Jr, MD

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TOPICAL REVIEWUsing the National Institutes of Health Stroke Scale: A Cautionary Tale 513Patrick Lyden, MD

BASIC SCIENCES ADVANCES FOR CLINICIANSNew Insight Into the Pathogenesis of Cerebral Small-Vessel Diseases 520Kristin Müller; Gilles Courtois, PhD; Matilde Valeria Ursini, PhD; Markus Schwaninger, MD

COCHRANE CORNERCognitive Rehabilitation for Memory Deficits After Stroke: An Updated Review e28Roshan das Nair, BA, MSc, MPhil (Clin Psychol), PhD; Heather Cogger, BSc, MSc; Esme Worthington, BSc, PhD; Nadina B. Lincoln, BSc, MSc, PhD

AHA/ASA SCIENTIFIC STATEMENTPoststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

e30

Amytis Towfighi, MD, Chair; Bruce Ovbiagele, MD, MSc, MAS, FAHA, Vice Chair; Nada El Husseini, MD, MHSc; Maree L. Hackett, PhD; Ricardo E. Jorge, MD; Brett M. Kissela, MD, MS, FAHA; Pamela H. Mitchell, PhD, RN, FAHA; Lesli E. Skolarus, MD; Mary A. Whooley, MD; Linda S. Williams, MD, FAHA; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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Eric E. Smith, MD, MPH, FAHA, Chair; Gustavo Saposnik, MD, MSc, FAHA, Vice Chair; Geert Jan Biessels, MD, PhD; Fergus N. Doubal, PhD, FRCP; Myriam Fornage, MS, PhD, FAHA; Philip B. Gorelick, MD, MPH, FAHA; Steven M. Greenberg, MD, PhD, FAHA; Randall T. Higashida, MD, FAHA; Scott E. Kasner, MD, MS, FAHA; Sudha Seshadri, MD; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Functional Genomics and Translational Biology; and Council on Hypertension

LETTERS TO THE EDITORLetter by El-Battrawy et al Regarding Article, “Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review”

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Ibrahim El-Battrawy, MD; Martin Borggrefe, MD; Ibrahim Akin, MD

Response by Jung et al to Letter Regarding Article, “Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review”

e73

Jin-Man Jung, MD, PhD; Yong-Hyun Kim, MD, PhD; Woo-Keun Seo, MD, PhD

Letter by Nagai et al Regarding Article, “Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review”

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Michiaki Nagai, MD; Keigo Dote, MD; Masaya Kato, MD

Response by Jung et al to Letter Regarding Article, “Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review”

e75

Jin-Man Jung, MD, PhD; Jung Bin Kim, MD; Woo-Keun Seo, MD, PhD

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Letter by Hu and Wang Regarding Article, “Blood Flow Into Basilar Tip Aneurysms: A Predictor for Recanalization After Coil Embolization”

e76

Shen Hu, MD; Daming Wang, MD

Response by Sugiyama and Tominaga to Letter Regarding Article, “Blood Flow Into Basilar Tip Aneurysms: A Predictor for Recanalization After Coil Embolization”

e77

Shin-ichiro Sugiyama, MD; Teiji Tominaga, MD

CORRECTIONSCorrection to: Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

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Correction to: Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy

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Correction to: Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

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STROKE (ISSN 0039-2499) is published monthly by Wolters Kluwer Health, Inc., at 14700 Citicorp Drive, Bldg 3, Hagerstown, MD 21742. Business offices are located at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Production offices are located at 351 West Camden Street, Baltimore, MD 21201-2436. Individuals may subscribe for their personal use at the following rates for print subscriptions: $225 for AHA/ASA Domestic and International Members (excluding General Membership level), or $582 for domestic non-members and $721 for international non-members. AHA membership information can be found online at professional.heart.org. Periodicals postage paid at Hagerstown, MD, and additional mailing offices. POSTMASTER: Send address changes to STROKE, American Heart Association, Wolters Kluwer Health, Inc., PO Box 1610, Hagerstown, MD 21740.

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Print ISSN: 0039-2499. Online ISSN: 1524-4628 Copyright © 2017 American Heart Association, Inc. All rights reserved.

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