Florentino Lupercio

Left atrial appendage morphology assessment for risk stratification of embolic stroke in patients with atrial fibrillation: A meta-analysis

BACKGROUND Thromboembolic event (TE) risk stratification is performed by using CHA2DS2VASc score. It has been suggested that left atrial appendage (LAA) morphology independently influences TE risk in patients with nonvalvular atrial fibrillation. LAA morphology has been classified into 4 types: chicken wing, cauliflower, windsock, and cactus. OBJECTIVE The purpose of this study was to determine TE risk for each LAA morphology in patients with atrial fibrillation with low to intermediate TE risk. METHODS A systematic review of MEDLINE, Cochrane Library, and Embase for studies that used computed tomography, tridimensional transesophageal echocardiography, and cardiac magnetic resonance imaging to categorize the LAA morphologies with assessment of TE prevalence. Odds ratio (OR) and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. The fixed effects model was used, and if heterogeneity (I2) was >25%, effects were analyzed using a random model. RESULTS Eight studies with 2596 patients were included. Eighty-four percent (n=1872) of patients had a CHADS2 score of <2. TE risk was lower in chicken wing morphology than in non-chicken wing morphology (OR 0.46; 95% CI 0.36-0.58). Likewise, chicken wing morphology had lower TE risk than did other morphologies (chicken wing vs cauliflower: OR 0.38; 95% CI 0.26-0.56; chicken wing vs windsock: OR 0.48; 95% CI 0.31-0.73; chicken wing vs cactus: OR 0.49; 95% CI 0.36-0.66). CONCLUSION Patients with chicken wing LAA morphology are less likely to develop TE than patients with non-chicken wing morphology. LAA morphology may be a valuable criterion in predicting TE and could affect the stratification and anticoagulation management of patients with low to intermediate TE risk.

Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction.

Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction≥55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction<55%). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61% were women, and the patients were followed for 2.26±1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p=0.007 and p<0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p<0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.

Where Is the Lead?: An Unusual Progression of Lead Fracture

A 64-year-old woman with Jervell and Lange-Nielsen syndrome and ventricular fibrillation being treated with nadolol was evaluated for shortness of breath. A dual-chamber implantable cardioverter-defibrillator (device model CD2207-36Q; ventricular lead model 7122Q/58; and atrial lead model 1688TC/52

Myocardial Infarction after Endoscopic Removal of Foreign Body

The development of cardiac complications during or after endoscopic procedures is rare. However, mortality from myocardial ischemia, particularly in the elderly population, is elevated. We illustrate the rare case of a 79-year-old man with multiple cardiovascular risk factors who developed a non-ST elevation myocardial infarction (NSTEMI) after endoscopic removal of a foreign body. This case report summarizes a rare complication of a low-risk procedure and highlights the importance of considering this potential adverse event, particularly in patients with significant cardiovascular risk factors, to promote early diagnosis and proper treatment.

A RETROSPECTIVE ANALYSIS OF LOW FLOW, LOW GRADIENT SEVERE AORTIC STENOSIS WITH NORMAL EJECTION FRACTION: MORTALITY AND NEED FOR VALVE REPLACEMENT, A SINGLE CENTER STUDY

Low flow, low gradient aortic stenosis with normal ejection fraction (LFLGNEF) is considered a seldom-[[Unsupported Character – Codename]]studied entity of the aortic stenosis spectrum (AS). Whether LFLGNEF has a worse prognosis than severe AS remains controversial. We retrospectively identified