The Correlation between Epicardial Adipose Tissue Thickness Measured by Echocardiography and P-Wave Dispersion and Atrial Fibrillation
Background: Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to...
Saved in:
Published in | Reviews in cardiovascular medicine Vol. 25; no. 8; p. 287 |
---|---|
Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Singapore
IMR Press
01.08.2024
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Background: Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to explore the correlation EAT, as measured by echocardiography, and P-wave dispersion (Pd) in the context of atrial fibrillation. Additionally, the study seeks to analyze the utility of EAT at different anatomical sites in identifying individuals who are predisposed to atrial fibrillation. Methods: A total of 136 subjects were enrolled and categorized into groups based on the guidelines: paroxysmal atrial fibrillation group (PAF group), persistent atrial fibrillation group (AF group), and non-atrial fibrillation group. Comprehensive clinical data, including general information and medications that could impact the occurrence of atrial fibrillation, were gathered for all patients. Echocardiography was employed to measure the maximum EAT thickness near the apex of the heart on the anterior right ventricular wall and near the base of the right ventricle for each participant. Pd values were computed for each patient based on standard 12-lead synchronous electrocardiogram (ECG). The study involved comparing the disparity in EAT thickness between the two specified sites across the three groups. Additionally, correlation analyses were performed to assess the relationship between EAT thickness at the two sites and Pd. Regression analysis was applied to explore potential risk factors for atrial fibrillation. The diagnostic value of EAT at each site in predicting atrial fibrillation was evaluated using Receiver Operating Characteristic curve (ROC) analysis. Results: EAT thickness of the anterior wall near the apex of the heart and near the base of the right ventricle were significantly positively correlated with Pd (p < 0.05), EAT thickness near the base and left atrial diameter were independent risk factors for atrial fibrillation (OR = 13.673, 95% CI 2.819~66.316, p = 0.001; OR = 2.294, 95% CI 1.020~5.156, p = 0.045). ROC analysis showed that the area under the curve of EAT thickness near the heart base was 0.723, and the best threshold for predicting the occurrence of AF was 1.05 cm. Conclusions: The echocardiography-measured epicardial adipose tissue thickness, particularly in proximity to the heart base, exhibits a significant correlation with Pd. Notably, EAT thickness near the heart base demonstrates superior predictive capability for atrial fibrillation compared to thickness near the apex. |
---|---|
AbstractList | Background: Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to explore the correlation EAT, as measured by echocardiography, and P-wave dispersion (Pd) in the context of atrial fibrillation. Additionally, the study seeks to analyze the utility of EAT at different anatomical sites in identifying individuals who are predisposed to atrial fibrillation. Methods: A total of 136 subjects were enrolled and categorized into groups based on the guidelines: paroxysmal atrial fibrillation group (PAF group), persistent atrial fibrillation group (AF group), and non-atrial fibrillation group. Comprehensive clinical data, including general information and medications that could impact the occurrence of atrial fibrillation, were gathered for all patients. Echocardiography was employed to measure the maximum EAT thickness near the apex of the heart on the anterior right ventricular wall and near the base of the right ventricle for each participant. Pd values were computed for each patient based on standard 12-lead synchronous electrocardiogram (ECG). The study involved comparing the disparity in EAT thickness between the two specified sites across the three groups. Additionally, correlation analyses were performed to assess the relationship between EAT thickness at the two sites and Pd. Regression analysis was applied to explore potential risk factors for atrial fibrillation. The diagnostic value of EAT at each site in predicting atrial fibrillation was evaluated using Receiver Operating Characteristic curve (ROC) analysis. Results: EAT thickness of the anterior wall near the apex of the heart and near the base of the right ventricle were significantly positively correlated with Pd (p < 0.05), EAT thickness near the base and left atrial diameter were independent risk factors for atrial fibrillation (OR = 13.673, 95% CI 2.819~66.316, p = 0.001; OR = 2.294, 95% CI 1.020~5.156, p = 0.045). ROC analysis showed that the area under the curve of EAT thickness near the heart base was 0.723, and the best threshold for predicting the occurrence of AF was 1.05 cm. Conclusions: The echocardiography-measured epicardial adipose tissue thickness, particularly in proximity to the heart base, exhibits a significant correlation with Pd. Notably, EAT thickness near the heart base demonstrates superior predictive capability for atrial fibrillation compared to thickness near the apex. Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to explore the correlation EAT, as measured by echocardiography, and P-wave dispersion (Pd) in the context of atrial fibrillation. Additionally, the study seeks to analyze the utility of EAT at different anatomical sites in identifying individuals who are predisposed to atrial fibrillation. A total of 136 subjects were enrolled and categorized into groups based on the guidelines: paroxysmal atrial fibrillation group (PAF group), persistent atrial fibrillation group (AF group), and non-atrial fibrillation group. Comprehensive clinical data, including general information and medications that could impact the occurrence of atrial fibrillation, were gathered for all patients. Echocardiography was employed to measure the maximum EAT thickness near the apex of the heart on the anterior right ventricular wall and near the base of the right ventricle for each participant. Pd values were computed for each patient based on standard 12-lead synchronous electrocardiogram (ECG). The study involved comparing the disparity in EAT thickness between the two specified sites across the three groups. Additionally, correlation analyses were performed to assess the relationship between EAT thickness at the two sites and Pd. Regression analysis was applied to explore potential risk factors for atrial fibrillation. The diagnostic value of EAT at each site in predicting atrial fibrillation was evaluated using Receiver Operating Characteristic curve (ROC) analysis. EAT thickness of the anterior wall near the apex of the heart and near the base of the right ventricle were significantly positively correlated with Pd ( 0.05), EAT thickness near the base and left atrial diameter were independent risk factors for atrial fibrillation (OR = 13.673, 95% CI 2.819~66.316, = 0.001; OR = 2.294, 95% CI 1.020~5.156, = 0.045). ROC analysis showed that the area under the curve of EAT thickness near the heart base was 0.723, and the best threshold for predicting the occurrence of AF was 1.05 cm. The echocardiography-measured epicardial adipose tissue thickness, particularly in proximity to the heart base, exhibits a significant correlation with Pd. Notably, EAT thickness near the heart base demonstrates superior predictive capability for atrial fibrillation compared to thickness near the apex. Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to explore the correlation EAT, as measured by echocardiography, and P-wave dispersion (Pd) in the context of atrial fibrillation. Additionally, the study seeks to analyze the utility of EAT at different anatomical sites in identifying individuals who are predisposed to atrial fibrillation.BackgroundRecent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to explore the correlation EAT, as measured by echocardiography, and P-wave dispersion (Pd) in the context of atrial fibrillation. Additionally, the study seeks to analyze the utility of EAT at different anatomical sites in identifying individuals who are predisposed to atrial fibrillation.A total of 136 subjects were enrolled and categorized into groups based on the guidelines: paroxysmal atrial fibrillation group (PAF group), persistent atrial fibrillation group (AF group), and non-atrial fibrillation group. Comprehensive clinical data, including general information and medications that could impact the occurrence of atrial fibrillation, were gathered for all patients. Echocardiography was employed to measure the maximum EAT thickness near the apex of the heart on the anterior right ventricular wall and near the base of the right ventricle for each participant. Pd values were computed for each patient based on standard 12-lead synchronous electrocardiogram (ECG). The study involved comparing the disparity in EAT thickness between the two specified sites across the three groups. Additionally, correlation analyses were performed to assess the relationship between EAT thickness at the two sites and Pd. Regression analysis was applied to explore potential risk factors for atrial fibrillation. The diagnostic value of EAT at each site in predicting atrial fibrillation was evaluated using Receiver Operating Characteristic curve (ROC) analysis.MethodsA total of 136 subjects were enrolled and categorized into groups based on the guidelines: paroxysmal atrial fibrillation group (PAF group), persistent atrial fibrillation group (AF group), and non-atrial fibrillation group. Comprehensive clinical data, including general information and medications that could impact the occurrence of atrial fibrillation, were gathered for all patients. Echocardiography was employed to measure the maximum EAT thickness near the apex of the heart on the anterior right ventricular wall and near the base of the right ventricle for each participant. Pd values were computed for each patient based on standard 12-lead synchronous electrocardiogram (ECG). The study involved comparing the disparity in EAT thickness between the two specified sites across the three groups. Additionally, correlation analyses were performed to assess the relationship between EAT thickness at the two sites and Pd. Regression analysis was applied to explore potential risk factors for atrial fibrillation. The diagnostic value of EAT at each site in predicting atrial fibrillation was evaluated using Receiver Operating Characteristic curve (ROC) analysis.EAT thickness of the anterior wall near the apex of the heart and near the base of the right ventricle were significantly positively correlated with Pd (p < 0.05), EAT thickness near the base and left atrial diameter were independent risk factors for atrial fibrillation (OR = 13.673, 95% CI 2.819~66.316, p = 0.001; OR = 2.294, 95% CI 1.020~5.156, p = 0.045). ROC analysis showed that the area under the curve of EAT thickness near the heart base was 0.723, and the best threshold for predicting the occurrence of AF was 1.05 cm.ResultsEAT thickness of the anterior wall near the apex of the heart and near the base of the right ventricle were significantly positively correlated with Pd (p < 0.05), EAT thickness near the base and left atrial diameter were independent risk factors for atrial fibrillation (OR = 13.673, 95% CI 2.819~66.316, p = 0.001; OR = 2.294, 95% CI 1.020~5.156, p = 0.045). ROC analysis showed that the area under the curve of EAT thickness near the heart base was 0.723, and the best threshold for predicting the occurrence of AF was 1.05 cm.The echocardiography-measured epicardial adipose tissue thickness, particularly in proximity to the heart base, exhibits a significant correlation with Pd. Notably, EAT thickness near the heart base demonstrates superior predictive capability for atrial fibrillation compared to thickness near the apex.ConclusionsThe echocardiography-measured epicardial adipose tissue thickness, particularly in proximity to the heart base, exhibits a significant correlation with Pd. Notably, EAT thickness near the heart base demonstrates superior predictive capability for atrial fibrillation compared to thickness near the apex. |
Author | Zhang, Qing-xue Liu, Zhi-jian Li, Xiu-chang Zhao, Xiao-hui Liu, Xiao-hong |
AuthorAffiliation | 1 Department of Echocardiography, The Second Affiliated Hospital of Shandong First Medical University, 271000 Taian, Shandong, China 2 Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, 271000 Taian, Shandong, China |
AuthorAffiliation_xml | – name: 2 Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, 271000 Taian, Shandong, China – name: 1 Department of Echocardiography, The Second Affiliated Hospital of Shandong First Medical University, 271000 Taian, Shandong, China |
Author_xml | – sequence: 1 givenname: Qing-xue surname: Zhang fullname: Zhang, Qing-xue – sequence: 2 givenname: Zhi-jian surname: Liu fullname: Liu, Zhi-jian – sequence: 3 givenname: Xiao-hong surname: Liu fullname: Liu, Xiao-hong – sequence: 4 givenname: Xiao-hui surname: Zhao fullname: Zhao, Xiao-hui – sequence: 5 givenname: Xiu-chang surname: Li fullname: Li, Xiu-chang |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39228499$$D View this record in MEDLINE/PubMed |
BookMark | eNpVkk2P0zAQhi20iP2AI1fkI5cs_ogT-4Sq0oWVFsGhiKM1diatSxoHO13UP8DvJm2XhT3NaOad55Vm5pKc9bFHQl5zdi050_Ld5jr5rVBMC10_IxeCK1loXpdn5GJKWVEpxc7JZc4bxqRQWr4g59IIoUtjLsjv5RrpPKaEHYwh9tTh-Auxp4sheEhNgI7OmjDEjHQZct5NYR38jx5zpp8R8i5hQ92eLvw6HgfiKsGw3lPoG_q1-A73SD-EPGDKB_yhOhvTAXsTXArdyfYled5Cl_HVQ7wi324Wy_mn4u7Lx9v57K7wJWdj0RpdS6yFq3zpRG1cDVI5CUZVvFJGG2C-AV8hVBpb7isj0GjGWlej5lLKK3J74jYRNnZIYQtpbyMEeyzEtLKQxuA7tGBg2qri3mtd8tI53epGuLphYErG-MR6f2INO7fFxmM_JuieQJ92-rC2q3hvOZdVzZiaCG8fCCn-3GEe7TZkj9NOeoy7bKcDM1UJrcUkffO_2aPL30tOguIk8CnmnLB9lHBmj59iN_bfp8g_Xo2zKQ |
Cites_doi | 10.1038/s41569-022-00679-9 10.3390/ijms20235989 10.17219/acem/127680 10.1093/europace/euy227 10.1093/eurheartj/ehab648 10.1111/obr.13277 10.1111/jebm.12542 10.1016/j.jacc.2012.03.042 10.1161/CIRCEP.116.004614 10.1111/pace.13825 10.1016/j.echo.2009.10.013 10.1016/j.pcad.2023.04.006 10.7759/cureus.46153 10.1161/CIRCEP.109.912055 10.1016/0305-0491(89)90337-4 10.1016/j.ihj.2015.08.005 10.1136/bmj.39227.551713.AE 10.1016/j.hrthm.2018.06.025 10.1016/j.jcmg.2021.04.027 10.1001/jama.2020.23700 10.1016/S0002-8703(98)70030-4 |
ContentType | Journal Article |
Copyright | Copyright: © 2024 The Author(s). Published by IMR Press. Copyright: © 2024 The Author(s). Published by IMR Press. 2024 |
Copyright_xml | – notice: Copyright: © 2024 The Author(s). Published by IMR Press. – notice: Copyright: © 2024 The Author(s). Published by IMR Press. 2024 |
DBID | AAYXX CITATION NPM 7X8 5PM DOA |
DOI | 10.31083/j.rcm2508287 |
DatabaseName | CrossRef PubMed MEDLINE - Academic PubMed Central (Full Participant titles) Directory of Open Access Journals (DOAJ) |
DatabaseTitle | CrossRef PubMed MEDLINE - Academic |
DatabaseTitleList | CrossRef PubMed MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: DOA name: DOAJ (Directory of Open Access Journals) url: https://www.doaj.org/ sourceTypes: Open Website – sequence: 2 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2153-8174 |
ExternalDocumentID | oai_doaj_org_article_a9a25051cc88414bb8f8d2b7d0a94001 PMC11367005 39228499 10_31083_j_rcm2508287 |
Genre | Journal Article |
GroupedDBID | --- 123 53G AAFWJ AAWTL AAYXX AENEX AFPKN ALMA_UNASSIGNED_HOLDINGS CITATION EBD EMOBN F5P GROUPED_DOAJ HLU O-U OK1 PGMZT RPM SV3 TUS NPM 7X8 5PM |
ID | FETCH-LOGICAL-c410t-f9873e72b6c4b279b7a35b3a956165989a0cdac6ea68ef1c692e9800fb7e81333 |
IEDL.DBID | DOA |
ISSN | 1530-6550 2153-8174 |
IngestDate | Wed Aug 27 01:31:09 EDT 2025 Thu Aug 21 18:35:58 EDT 2025 Fri Jul 11 11:30:27 EDT 2025 Thu Jan 02 22:38:03 EST 2025 Tue Jul 01 00:57:32 EDT 2025 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 8 |
Keywords | epicardial adipose tissue atrial fibrillation P-wave dispersion echocardiography |
Language | English |
License | https://creativecommons.org/licenses/by/4.0 Copyright: © 2024 The Author(s). Published by IMR Press. This is an open access article under the CC BY 4.0 license. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c410t-f9873e72b6c4b279b7a35b3a956165989a0cdac6ea68ef1c692e9800fb7e81333 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
OpenAccessLink | https://doaj.org/article/a9a25051cc88414bb8f8d2b7d0a94001 |
PMID | 39228499 |
PQID | 3100562882 |
PQPubID | 23479 |
ParticipantIDs | doaj_primary_oai_doaj_org_article_a9a25051cc88414bb8f8d2b7d0a94001 pubmedcentral_primary_oai_pubmedcentral_nih_gov_11367005 proquest_miscellaneous_3100562882 pubmed_primary_39228499 crossref_primary_10_31083_j_rcm2508287 |
ProviderPackageCode | CITATION AAYXX |
PublicationCentury | 2000 |
PublicationDate | 2024-08-01 |
PublicationDateYYYYMMDD | 2024-08-01 |
PublicationDate_xml | – month: 08 year: 2024 text: 2024-08-01 day: 01 |
PublicationDecade | 2020 |
PublicationPlace | Singapore |
PublicationPlace_xml | – name: Singapore |
PublicationTitle | Reviews in cardiovascular medicine |
PublicationTitleAlternate | Rev Cardiovasc Med |
PublicationYear | 2024 |
Publisher | IMR Press |
Publisher_xml | – name: IMR Press |
References | ref13 ref12 ref15 ref14 ref20 ref11 ref10 ref21 ref2 ref1 ref17 ref16 ref19 ref18 ref8 ref7 ref9 ref4 ref3 ref6 ref5 |
References_xml | – ident: ref8 doi: 10.1038/s41569-022-00679-9 – ident: ref18 doi: 10.3390/ijms20235989 – ident: ref14 doi: 10.17219/acem/127680 – ident: ref6 doi: 10.1093/europace/euy227 – ident: ref1 doi: 10.1093/eurheartj/ehab648 – ident: ref9 doi: 10.1111/obr.13277 – ident: ref3 doi: 10.1111/jebm.12542 – ident: ref15 doi: 10.1016/j.jacc.2012.03.042 – ident: ref11 doi: 10.1161/CIRCEP.116.004614 – ident: ref19 doi: 10.1111/pace.13825 – ident: ref20 doi: 10.1016/j.echo.2009.10.013 – ident: ref4 doi: 10.1016/j.pcad.2023.04.006 – ident: ref2 doi: 10.7759/cureus.46153 – ident: ref12 doi: 10.1161/CIRCEP.109.912055 – ident: ref16 doi: 10.1016/0305-0491(89)90337-4 – ident: ref17 doi: 10.1016/j.ihj.2015.08.005 – ident: ref5 doi: 10.1136/bmj.39227.551713.AE – ident: ref10 doi: 10.1016/j.hrthm.2018.06.025 – ident: ref21 doi: 10.1016/j.jcmg.2021.04.027 – ident: ref7 doi: 10.1001/jama.2020.23700 – ident: ref13 doi: 10.1016/S0002-8703(98)70030-4 |
SSID | ssj0032583 |
Score | 2.346097 |
Snippet | Background: Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as... Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial... |
SourceID | doaj pubmedcentral proquest pubmed crossref |
SourceType | Open Website Open Access Repository Aggregation Database Index Database |
StartPage | 287 |
SubjectTerms | atrial fibrillation echocardiography epicardial adipose tissue Original Research p-wave dispersion |
Title | The Correlation between Epicardial Adipose Tissue Thickness Measured by Echocardiography and P-Wave Dispersion and Atrial Fibrillation |
URI | https://www.ncbi.nlm.nih.gov/pubmed/39228499 https://www.proquest.com/docview/3100562882 https://pubmed.ncbi.nlm.nih.gov/PMC11367005 https://doaj.org/article/a9a25051cc88414bb8f8d2b7d0a94001 |
Volume | 25 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Nb9QwELWqHlAvFR-lhI_KSBW30E1ix_axlF1VSFv1sBW9RR5noi6U7KrdIvEH-N3M2NnSRUhcuOwhm9iW38Tzxhm_EeIQXG0q1BSpgtK5QtS5x2BzsLrtTGdbE9X2p2f16YX6dKkvH5T64pywJA-cJu7IO89eugjBWlUoAEsNlGDakeea3jHwIZ-3DqbSGlyVOgpw0utMwRGR8KSuSVTGVkdf3t-Eb9QmS71veKMo2v83pvlnwuQDDzR5LHYH6iiP05CfiC3sn4pH0-Hj-DPxkyCXJ1xtI-W3ySEHS46XhAQbAj3czpeLW5SzON9ydjUPX3mxk9O0V9hK-CHHtCTGBwY5a-n7Vp7nn_13lB_nLC3OW2zx6nGs-iEnfHDgOnW7Jy4m49nJaT6UWciDKkarvHOW4DIl1EFBaRwYX2moPB95rbWzzo9C60ONvrbYFaF2JTrimR0YtBTiVs_Fdr_o8YWQnQp84AR0G-jXWQ-AWAAysensSGXi3Xq6m2VS02goCom4UBjyG5dMfGAw7m9iEex4gUyjGUyj-ZdpZOLtGsqGXhr-EuJ7XNzdcodM_Ci6yMR-gva-KyKM5LKdy4TdAH1jLJv_9POrKMzN9XEMtfzyf4z-ldgpiUClZMPXYnt1c4dviACt4CDa-kHcmfoFlFYGHA |
linkProvider | Directory of Open Access Journals |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+Correlation+between+Epicardial+Adipose+Tissue+Thickness+Measured+by+Echocardiography+and+P-Wave+Dispersion+and+Atrial+Fibrillation&rft.jtitle=Reviews+in+cardiovascular+medicine&rft.au=Qing-xue+Zhang&rft.au=Zhi-jian+Liu&rft.au=Xiao-hong+Liu&rft.au=Xiao-hui+Zhao&rft.date=2024-08-01&rft.pub=IMR+Press&rft.issn=1530-6550&rft.volume=25&rft.issue=8&rft.spage=287&rft_id=info:doi/10.31083%2Fj.rcm2508287&rft.externalDBID=DOA&rft.externalDocID=oai_doaj_org_article_a9a25051cc88414bb8f8d2b7d0a94001 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1530-6550&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1530-6550&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1530-6550&client=summon |