CHA2DS2-VASc score as predictor of stroke and all-cause death in stable ischaemic heart disease patients without atrial fibrillation.

BACKGROUND: Cerebrovascular and coronary artery disease share risk factors. The aim was to study CHA2DS2-VASc score as predictor of stroke incidence and death in a sample of patients with sinus rhythm and stable ischemic heart disease (sIHD) during long-term follow-up. METHODS: 1184 patients with sIHD and without atrial fibrillation were included in this single-centre prospective cohort study between February 2000 and January 2004. Stroke and death prediction abilities of CHA2DS2-VASc score in this population were investigated. RESULTS: The median age was 66 (interquartile range (IQR), 60-73 years). The mean follow-up was 11.2 ± 10 years (maximum 17 years). Along this period, 137 patients (11.6% of the sample) suffered a stroke. The mean value of CHA2DS2-VASc score was 3.04 ± 1.36, with CHA2DS2-VASc score ≤ 4 in 85.5% of the sample. Higher CHA2DS2-VASc score at baseline was associated with higher risk of suffering stroke (Hazard Ratio = 1.36, 95% CI 1.20-1.54, p < 0,001) and all-cause death during follow-up (Hazard Ratio = 1.49, 95% CI 1.40-1.58, p < 0,001). CONCLUSIONS: Higher CHA2DS2-VASc score values were associated with higher risk of stroke and all-cause mortality during long-term follow-up in this real-world sample of patients with sIHD in sinus rhythm.

Usefulness of transesophageal echocardiography during implantation of the CoreValve percutaneous aortic prosthesis: influence of the learning curve.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the usefulness of transesophageal echocardiography during the implantation of the CoreValve percutaneous aortic prosthesis and the influence of the learning curve in its indications. METHODS: From April 2008 to January 2010, 53 patients were treated for symptomatic severe aortic stenosis with a CoreValve percutaneous aortic prosthesis. Transesophageal echocardiography was performed during the procedure for two reasons: if a discrepancy between the measures of the aortic annulus arose before the implantation and to provide visualization if a complication occurred during the procedure. Patients were divided in to two groups based on the learning curve (group I:the first 25 patients, group II: all of the subsequent patients). RESULTS: Thirty-six transesophageal echocardiographies were performed on 28 patients (53%).In 15 cases the indication was to assist us in determining the proper sized prosthesis, and in the other 21 cases it was performed due to a complication during the procedure. The numbers of intraprocedure transesophageal echocardiographies were similar in both learning-curve groups, (64% in group I vs. 71% in group II, P = 0.56) but the proportion of the studies indicated by serious complications was significantly lower in the second period of the learning curve (67% in group I vs. 17% in group II, P < 0.05). CONCLUSIONS: In our experience, transesophageal echocardiography was very useful in more than one-half of the patients during the implantation of the CoreValve percutaneous aortic prosthesis. After overcoming the learning curve, its indication due to serious procedure-related complications decreased significantly.

Three-dimensional echocardiography-guided repair of residual shunt after percutaneous atrial septal defect closure.

A 28-year-old woman was referred to closure of a residual shunt produced through a percutaneous device previously implanted in the atrial septum. The imaging protocol to guide the procedure included 2D TEE and real time 3D (RT3D) transesophageal echocardiography (TEE) imaging. RT3D TEE facilitated the evaluation of the defect morphology, and the relationship with the previous device, allowing a proper understanding of the mechanism responsible for the residual shunt. It was also a useful tool for guiding device deployment, providing clear intraprocedural information about catheter position and the spatial relationship with the previous device. In conclusion, RT3D TEE and 2D TEE are complementary techniques for the evaluation and guidance of transcatheter closure of complex atrial septal defects.