High CHA Research Articles

Investigation of physical, mechanical and in-vitro bioactivity of bioactive glass-ceramics fabricated from waste soda-lime-silica glass doped P2O5 by microwave irradiation sintering

The ever-increasing generation of waste glass, poses a major environmental challenges due to its large volume and limited recycling options. This research explores a novel sustainable approach to repurposing this waste by transforming it into silicate based bioactive glass-ceramics (SBGCs). The glass waste was recycled into powder form and homogeneously mixed with sodium dihydrogen orthophosphate (NaH2PO4) in the step of 2, 4, 6, 8 and 10 wt % respectively with addition of organic binder and sintered by microwave irradiation approach. The obtained SBGCs were then characterized for its phase constituents, microstructure, physical, mechanical, and in-vitro bioactivity behaviour. The results showed that the samples exhibited considerable density and porosity while both the micro-hardness and compressive strength decreased with increased phosphate content. Sample SLP2% showed optimum hardness and compressive strength of 7.3 GPa and 87 MPa respectively. Combeite was obtained as the major phase while wollastonite and quartz were also detected. The developed SBGCs also showed increased hydroxyapatite (HA) formation after immersion in simulated body fluid (SBF) and displayed good antibacterial capacity when reacted with four bacteria strains. The results obtained indicate that the developed SBGCs might be considered a potential candidate for biomedical applications. However, sample SLP8% is the best sample to serve as bioactive glass-ceramics considering the combination of its high HA and good CHA formation, besides its considerable density and mechanical properties.

Comparative Effectiveness of Ibrutinib Flexible Dosing Treatment Strategies on Time to Next Treatment in a Largely Community-Based Claims Database: A Target Trial Emulation Study

Introduction: Outside of a clinical trial setting, ibrutinib is the most well-characterized of the covalent Bruton's tyrosine kinase inhibitors used in the treatment of patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) in the first-line (1L) setting. However, the impact of ibrutinib dose adjustment on clinical outcomes remains to be defined. In this real-world effectiveness study, we compared time to next treatment (TTNT) as a proxy for disease progression for dose adjustment and standard dose treatment strategies in patients with CLL/SLL receiving 1L single-agent IBR. Methods: This study utilized the Komodo Health payer-complete dataset, derived from U.S. health insurance claims from >150 private insurers covering >160 million individuals from 2015-2023; 53% of these patients are from community centers. Adult patients with CLL/SLL were included if they initiated 1L single-agent IBR 420 mg/day between March 2016 - April 2023 (IBR initiation date = index date; 1L single-agent IBR was defined as no other CLL/SLL treatment in the 12-month baseline period or within 28 days after index). A target trial emulation (TTE) approach was utilized to compare TTNT, defined as the time between the index date to the initiation of a next line of therapy (LOT), for two treatment strategies: 1) Dose adjustment strategy, defined as a lead-in IBR treatment at 420mg/day for 3-12 months, followed by dose adjustment to <420mg/day until next LOT or IBR discontinuation; 2) Standard dose strategy, defined as a continuous IBR treatment at 420mg/day without any dose adjustment for >12 months until next LOT or IBR discontinuation. The TTE approach minimizes immortal time bias in a naïve observational analysis as patients in the dose adjustment cohort cannot initiate next LOT before dose adjustment occurs [Hernan et al. Am J Epidemiol. 2016]. To explicitly emulate a target trial, two clones were created for each patient, with one clone contributing person-time and event to each treatment strategy of interest, respectively. A clone was artificially censored when the actual treatment path deviated from the assigned treatment strategy. Selection bias due to artificial censoring was corrected using time-varying inverse probability of censoring weights (IPCW), accounting for post-index time-varying clinical factors related to IBR dose adjustment or IBR discontinuation. TTNT hazard ratio (HR; robust 95% confidence interval [CI]) was estimated using an IPCW-weighted pooled logistic regression model. Alternative lead-in periods with IBR standard dosing (3-6 and 3-9 months) were also evaluated. A subgroup analysis was conducted among patients with high cardiovascular (CV) risk, defined as having a preexisting CV comorbidity or a high CHA 2DS 2-Vasc risk score. Results: 3,342 adults initiated 1L single-agent IBR at 420 mg/day. Mean (standard deviation [SD]) age was 67.5 (10.6) years, 62% were male, and mean (SD) Quan-Charlson Comorbidity Index score was 3.0 (1.5). The median (interquartile range) follow-up duration was 19.6 (7.5, 35.0) months. During the study period, 463 patients (14%) initiated a subsequent LOT. The high CV risk subgroup consisted of 2,640 (79%) patients. In the overall study population, 608 (18%) patients experienced a dose adjustment after the index date. Of those, the dose adjustment occurred ≤3 months, ≤6 months, and ≤12 months post-index in 159 (26%), 300 (49%), and 440 (72%) patients, respectively, with dose used at the first reduction of 70 mg, 140 mg, or 280 mg in 4 (1%), 85 (14%), and 519 (85%) patients, respectively. The dose adjustment strategy (420 mg/day for 3-12 months followed by a reduced dose) was not associated with increased risk of initiating next LOT (adjusted HR [95% CI] 0.95 [0.80, 1.14]) compared to the continuous standard dose strategy; results for the alternative lead-in periods and the high CV risk subgroup were consistent with the primary scenario. Conclusions: In this real-world comparative effectiveness study with the majority of patients from community centers, dose adjustment of 1L single-agent IBR treatment for CLL/SLL is not associated with an increased risk of initiating next LOT when compared to continuous standard dose treatment. These findings suggest that a flexible dosing approach with IBR may be an effective option to maintain an optimal balance of clinical therapeutic efficacy and safety for patients with CLL/SLL in the 1L setting.

Long duration of atrial high-rate episode is more favorable in predicting ischemic stroke than high CHA2 DS2 -VASc score.

This study aimed to explore the roles of duration and burden of atrial high-rate episode (AHRE) on ischemic stroke in patients with pacemaker implantation. Patients with pacemaker implantation for bradycardia from 2013 to 2017 were consecutively enrolled. Data such as gender, age, combined diseases, type of AF, left atrial size, left ventricular size, left ventricular ejection fraction, CHA2 DS2 -VASc score, and anticoagulants were collected. The burden and duration of AHRE based on different interval partition were also recorded in detail to evaluate the impacts on ischemic stroke. Cox regression analysis with time-dependent covariates was conducted. A total of 220 patients with AHRE were enrolled. The average follow-up time was 48.42±17.20 months. Univariate regression analysis showed that diabetes (p=.024), high CHA2 DS2 -VASc score (≥ 2) (p=.021), long mean AHRE burden (p=.011), long maximal AHRE burden (p=.015), long AHRE duration lasting≥48h (p=.001) or 24h (p=.001) or 12h (p=.005) were prone to ischemic stroke. Further multivariate regression analysis showed that long duration of AHRE (≥48h) (HR 10.77; 95% CI 3.22-55.12; p=.030) were significantly correlated with stroke in patients with paroxysmal AF. There was no significant correlation between the type of AF and stroke (p=.927). The longer duration of AHRE (≥48h) was more favorable in predicting ischemic stroke than high CHA2 DS2 -VASc score (≥2).

Personal recording devices for arrhythmia detection.

Persistent cardiac arrhythmias are readily amenable to detection by performing a standard electrocardiogram (ECG), but detection of transient (paroxysmal) arrhythmias has long been a significant cause of frustration to both doctors and patients. Often a significantly symptomatic arrhythmia is experienced by the patient but terminates before an ECG can be recorded to allow diagnosis. Prognostically important treatment is often delayed, and recurrent symptomatic attacks represent a high morbidity in patients' lives and result in a burden on emergency services, who often arrive after the arrhythmia has terminated with no resultant progress in making a diagnosis. Another area of concern has been the presence of asymptomatic, but clinically important, arrhythmias that can go unnoticed by people experiencing them and may result in permanent harm; asymptomatic paroxysmal atrial fibrillation in patients with high CHA 2 DS 2-VASc scores being the most common example. Both these issues are now being importantly addressed by the widespread availability of portable ECG recording devices, which patients can either manually activate themselves or program to automatically detect abnormal arrhythmias. Information on the range of devices available and their strengths and weaknesses is limited. This article aims to provide a helpful overview for patients and doctors advising them.

The Association Between High CHA2DS2-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

BackgroundThe CHA2DS2-VASc score has been associated with the prognosis of cardiovascular diseases. This study aimed to explore the association between the CHA2DS2-VASc score and all-cause mortality in coronary care unit (CCU) patients.MethodsThe study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. CCU patients were divided into two groups according to CHA2DS2-VASc score: 0-3 (low risk)，4-9 (intermediate and high risk). The primary outcome was 30-day mortality, and the secondary endpoints included in-hospital, 1-year, and 5-year mortality. Propensity score matching (PSM) and sensitivity analyzes for the confounders were also performed. The restricted cubic splines flexibility model was used to demonstrate the relation between red blood cell volume distribution width (RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC), hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in the 0-3 score versus the 4-9 score groups after PSM.ResultsAmong 4491 eligible patients, 988 patients with low CHA2DS2-VASc scores and 988 patients with intermediate and high CHA2DS2-VASc scores had similar propensity scores and were included in the analyzes. In the survival analysis, the patients with intermediate and high CHA2DS2-VASc scores were associated with higher 30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI), 1.02–1.20, P = .014], 1-year mortality [HR: 1.13; 95%CI, 1.06–1.19, P < .001], and 5-year mortality [HR: 1.13; 95%CI, 1.07–1.18, P < .001]. The interaction for 30-day mortality among subgroups was not significant between the 0-3 score versus the 4-9 score groups. The restricted cubic splines for 30-day mortality demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped trajectory for WBC, glucose and potassium, and a U-shaped trajectory for sodium, respectively (all nonlinear P <.001).ConclusionsA high CHA2DS2-VASc score was an independent risk for 30-day, 1-year, and 5-year mortality for CCU patients.

Real-World Persistence and Time to Next Treatment with Ibrutinib Treatment in Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Including Patients at High Risk for Atrial Fibrillation or Stroke

Real-World Persistence and Time to Next Treatment with Ibrutinib Treatment in Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Including Patients at High Risk for Atrial Fibrillation or Stroke

Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening

Background: Stroke risk scores (CHADS₂ and CHA₂DS₂-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. Objective: The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. Methods: We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS₂ and CHA₂DS₂-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. Results: A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA₂DS₂-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA₂DS₂-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA₂DS₂-VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS₂ scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. Conclusions: High CHA₂DS₂-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention

Objective: We aimed to investigate the relation between CHA₂DS₂-VASc score and microvascular dysfunction (MVD) assessed by the index of microvascular resistance (IMR) immediately after primary percutaneous intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). Subjects and Methods: The study included 115 consecutive patients with STEMI who underwent successful PPCI. Angiographic results of reperfusion were inspected to evaluate the association of high CHA₂DS₂-VASc score and IMR. Also, we assessed echocardiographic changes with respect to CHA₂DS₂-VASc score. Results: Subjects were stratified into 2 groups based on IMR </≥ 40 U; 72 patients (62.6) with IMR <40 U and 43 patients (37.4) with IMR ≥40 U. Patients with IMR ≥40 U had higher CHA₂DS₂-VASc score (p < 0.001). CHA₂DS₂-VASc score was significantly correlated with increased left atrial volume index, diastolic dysfunction, wall motion score index, and inversely correlated left ventricular ejection. Moreover, CHA₂DS₂-VASc score was strongly correlated with IMR (p < 0.001). At multivariate analysis, low systolic blood pressure, stent diameter, and CHA₂DS₂-VASc score were associated with MVD. Besides, CHA₂DS₂-VASc score ≥4 was the optimal value in predicting MVD (IMR ≥40) in STEMI patients. Conclusions: The data of the current study point out that increased CHA₂DS₂-VASc score, lower systolic blood pressure <90 mm Hg, and stent diameter are associated with increased incidence of MVD (increased IMR) after PPCI of STEMI. We suggest that the CHA₂DS₂-VASc score may be a simple, inexpensive useful risk score for the prediction of MVD risk after PPCI for STEMI patients.

Assessment of the CHA2DS2-VASc Score in Predicting Mortality and Adverse Cardiovascular Outcomes of Patients on Hemodialysis

Background: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis are at high mortality and cardiovascular risk. This study was aimed to assess whether the CHA₂DS₂-VASc score may be used for risk stratification of this population. Methods: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA₂DS₂-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA₂DS₂-VASc score: 0–3 (low), 4–5 (intermediate), and ≥6 (high). The primary endpoint was the composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis. Results: Of the 457 patients with ESRD, 181 (40%) had low, 193 (42%) intermediate, and 83 (18%) high CHA₂DS₂-VASc scores. During the first year of hemodialysis, 109 (23.8%) patients died, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA₂DS₂-VASc score group, those in the intermediate and high score groups had higher risk for the composite endpoint (OR: 2.6, 95% CI: 1.6–4.2, p < 0.01 and OR: 4.2, 95% CI: 2.3–7.5, p < 0.01, respectively). Each 1-point increase in CHA₂DS₂-VASc score was associated with a 38% increased risk for the composite endpoint, a 19% increased risk for 1-year myocardial infarction, and a 29% increased risk for 1-year stroke. Conclusions: Patients with ESRD are at an extremely high mortality and cardiovascular risk within the first year of hemodialysis. The CHA₂DS₂-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.

Implications of CHA2DS2-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

Background and Aims: The aim of this study was to investigate the stroke mechanisms and associated conditions influencing the decision regarding stroke thromboprophylaxis in patients with atrial fibrillation (AF) plus ischemic stroke, according to the CHA₂DS₂-VASc score. Methods: We evaluated 938 consecutive patients with a diagnosis of AF plus transient ischemic attack/ischemic stroke. Based on the CHA₂DS₂-VASc scores, patients were stratified as score 0 or 1 (n = 151), score 2 (n = 146), score 3 (n = 213), score 4 (n = 185), or score ≥5 (n = 243). Results: Patients with a higher CHA₂DS₂-VASc score were more likely to have noncardioembolic stroke mechanism (p = 0.001). Large-artery atherosclerosis causing stenosis >50% was more frequently observed in the high CHA₂DS₂-VASc group (p < 0.001). Coronary artery disease and the use of antiplatelet agents were more prevalent in the higher group (p < 0.001). A high CHA₂DS₂-VASc score was associated with a higher frequency of cerebral microbleeds and a higher Fazekas grade for leukoaraiosis (p < 0.001). The HAS-BLED score was correlated with the CHA₂DS₂-VASc score (γ = 0.650; p < 0.001). Conclusions: A higher CHA₂DS₂-VASc score is associated with noncardioembolic mechanisms of stroke and with a higher risk of bleeding. Strategies to treat macro/microangiopathy such as use of statin for plaque stabilization, as well as oral anticoagulants with a lower bleeding risk, are needed in these patients.

Preparation and characterization of high performance CHA zeolite membranes from clear solution

CHA zeolite membranes with Si/Al ratio of 2–3 have been successfully synthesized on the outer surface of yttria-stabilized zirconia (YSZ) hollow fibers from clear solution for the first time. The influence of synthesis parameters, such as precursor alkalinity, crystallization time and temperature, on the morphologies and dehydration performance of CHA zeolite membrane, were extensively investigated. Pervaporation (PV) results indicated that the separation performances of obtained CHA membranes were strongly influenced by the morphology of the membranes. The optimal synthesis condition was 140°C for 16h in the precursor of 22 SiO2: 1 Al2O3: 15 K2O: 1 Na2O: 4400 H2O. The as-synthesized membranes composed of flake-like grains exhibited a water permeation flux of 13.3kgm−2h−1 with separation factor of 6000 for the PV dehydration of 90wt% ethanol/water mixture at 75°C. The long-term (>550h) acid resistance of the as-synthesized CHA zeolite membranes ensures them the most promising candidate for PV dehydration of organic solvents containing acids.

Efficient and rapid transformation of high silica CHA zeolite from FAU zeolite in the absence of water

High quality CHA zeolite catalysts were efficiently synthesized by fast transformation of FAU zeolite in the absence of water.

Asymptomatic Pulmonary Embolism after Ablation

Background: Pulmonary embolism (PE) is a life-threatening event with a broad presentation spectrum ranging from asymptomatic cases to sudden cardiac arrest. It is unclear if right atrial emboli cause PE in patients with atrial fibrillation (AF) or if mild PE itself increases right cardiac pressure provoking AF. Objective: To determine the incidence and predictors of asymptomatic PE in patients undergoing AF ablation. Method and Results: Patients (n = 93) were screened and those with previous or current symptomatic PE or venous thromboembolism, pulmonary hypertension, increased right heart pressures detected on echocardiography, a history of stroke, transient ischemic attack, coagulopathy or cancer and inappropriate contrast for the evaluation of pulmonary arterial tree were excluded. The remaining AF patients (n = 71) underwent guided ablation controlled with 3-dimensional, left atrial and pulmonary venous computed tomography. The asymptomatic PE was defined by using the modified Miller score by 2 independent assessors in 6 patients. Univariate logistic regression showed that age (OR: 1.094, 95% CI 1.007-1.188, p = 0.033), diabetes (OR: 12.000, 95% CI 1.902-75.716, p = 0.008), CHA₂DS₂-VASc score (OR: 2.800, 95% CI 1.304-6.013, p = 0.008), and pulmonary artery diameter (OR: 1.221, 95% CI 1.033-1.444, p = 0.019) were significantly associated with PE. However, multivariate analysis revealed that the CHA₂DS₂-VASc score (p = 0.047) remained the exclusive significant predictor for asymptomatic PE. Conclusion: The incidence of random asymptomatic PE in AF patients is high (>8%). The CHA₂DS₂-VASc score can predict silent PE. Since patients with a high CHA₂DS₂-VASc score are already anticoagulated, our results do not change clinical practice but are noteworthy in terms of the cause-effect relationship between AF and PE.

P1 Diagnosis and stroke risk of atrial fibrillation in patients with atrial septal defects: A single centre experience

Background Atrial fibrillation (AF) is one of the most common sustained tachyarrhythmias. It increases risk of developing stroke by up to five times. There is an increased incidence in patients with adult congenital heart disease (ACHD). The CHA 2 DS 2 VASC scoring system is validated for assessing the risk of ischaemic stroke in AF in the general population. Its role in ACHD is unclear. This study assesses the burden of AF in patients with uncomplicated atrial septal defects (ASD). Methods A retrospective analysis of the ACHD database of all patients at a large quaternary specialist ACHD centre. Results 135 (3%) patients with a diagnosis of ASD and co-existing AF were identified out of 4500 patients under regular follow up at Queen Elizabeth Hospital Birmingham. 101 (75%) secundum ASD, 12 (9%) sinus venosus ASD, 1 (1%) coronary sinus ASD and 21 (15%) unclear. 47 (35%) surgical closures, 28 (21%) percutaneous closure, 57 (42%) unrepaired, 3 (2%) both surgical and percutaneous. There were 7 residual defects post closure. -The mean age was 67.8(+/-12.8) years, range 36–90 years, 65 male (48.1%). -The mean CHA 2 DS 2 VASC score was 2.21 (Range 0–6). -The mean age of onset of AF was 56(+/-12.3) years. In 40% the AF was asymptomatic. -90% of patients with a CHA 2 DS 2 VASC score of 2 or more were anticoagulated with either warfarin or a novel oral anticoagulant (n = 75). 11 patients had suffered a stroke (8.15%). -7 presented initially with a stroke and asymptomatic AF; of these 6 were also found to have ASDs after the stroke. The mean age stroke occurred was 58.7(+/-20) years. The mean CHA 2 DS 2 VASC score for patients who had a stroke was 4.18 (Range 2–6). Discussion The incidence of AF in ASDs is high and is frequently asymptomatic. AF and strokes occur at a young age in this population. A significant proportion of our patients presented for the first time with a stroke and asymptomatic AF. Expert consensus currently advocates screening for arrhythmias in certain ACHD groups but not ASD. This data suggest that patients with ASD should be actively screened for AF. The role of the CHA 2 DS 2 VASC score if unclear in these patients but a high CHA 2 DS 2 VASC does appear to correlate with a higher incidence of stroke.

Assessment of left atrium mechanical function by deformation imaging in atrial fibrillation and its correlation with CHA2DS2-VASc risk score

Abstract Objectives Evaluation of left atrium (LA) mechanical function by speckle tracking based strain (SPTS) in patients with chronic non-valvular atrial fibrillation (AF) and its correlation with CHA 2 DS 2 -VASc risk score. Background AF is a progressive condition that begins with increased hemodynamic load or structural remodeling of the atria, understanding atrial function could lead to better ability to predict the risk of developing stroke and the response to treatment. SPTS is a recently emerged modality that accurately estimates myocardial function. Methods Sixty patients with chronic AF and 20 age and sex matched normal control individuals underwent conventional echo where LV dimensions, wall thickness, EF, LA diameter and volumes were measured. Peak left atrial longitudinal strain (PALS) was measured in apical four (AP4) and two chamber view (AP2) and its correlation with CHA 2 DS 2 -VASc risk score in the AF group was evaluated. Results LA diameter and volumes were greater in AF patients ( P -value 2 DS 2 -VASc score. Also, there was no significant difference between PALS in patients with CHA 2 DS 2 -VASc score less than and more than two points. Conclusion AF leads to impairment of LA mechanical function as evidenced by low PALS but PALS was not significantly correlated with CHA 2 DS 2 -VASc score. Also, there was no significantly statistical difference between PALS in patients with low and high CHA 2 DS 2 -VASc scores.

The CHA2DS2-VASc Score as a Predictor of Left Atrial Thrombus in Patients with Non-Valvular Atrial Fibrillation

Objective: To investigate whether or not the CHA₂DS₂-VASc score predicts left atrial (LA) thrombus detected on pre-cardioversion transoesophageal echocardiography (TEE). Materials and Methods: The medical records of patients who had undergone TEE were reviewed to assess the presence of LA thrombus prior to direct-current cardioversion for atrial fibrillation (AF). The CHA₂DS₂-VASc score was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with a valve prosthesis or rheumatic mitral valve disease were excluded from this study. Results: A total of 309 patients were identified. The mean age was 70.1 ± 9.8 years and 151 (49%) patients were males and 158 (51%) were females. LA thrombus was seen in 32 (10.3%) of the 309 patients. Fifty (16.2%) patients had a low CHA₂DS₂-VASc score (0-1), 230 (74.4%) had an intermediate score (2-4) and 29 (9.4%) had a high score (5-9). The incidence of LA thrombus in the low, intermediate and high CHA₂DS₂-VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA₂DS₂-VASc scores. On multivariate logistic analysis, the CHA₂DS₂-VASc score (OR 3.26, 95% CI 2.3-4.65; p = 0.001) and age (OR 0.93, 95% CI 0.88-0.98; p = 0.004) were independent risk factors for LA thrombus in patients with non-valvular AF. Conclusion: A high CHA₂DS₂-VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF.

Usefulness of Transesophageal Echocardiography to Confirm Clinical Utility of CHA2DS2-VASc and CHADS2 Scores in Atrial Flutter

The CHA(2)DS(2)-VASc and CHADS(2) risk stratification schemes are used to predict thromboembolism and ischemic stroke in patients with atrial fibrillation. However, limited data are available regarding the utility of these risk stratification schemes for stroke in patients with atrial flutter. A retrospective analysis of 455 transesophageal echocardiographic studies in patients with atrial flutter was performed to identify left atrial (LA) thrombi and/or spontaneous echocardiographic contrast (SEC). The CHA(2)DS(2)-VASc (Congestive heart failure, Hypertension, Age ≥75 years [doubled risk weight], Diabetes mellitus, previous Stroke/transient ischemic attack [doubled risk weight], Vascular disease, Age 65 to 74 years, Sex) and CHADS(2) (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack [double risk weight]) scores were calculated to stratify the risk of stroke or transient cerebrovascular ischemic events. Transesophageal echocardiography revealed LA thrombi in 5.3% and SEC in 25.9% of patients. Using CHADS(2), LA thrombus was found in 2.2% of the low-intermediate-risk group and 8.3% of the high-risk group (p = 0.005). SEC was found in 19.8% of the low-intermediate-risk group and 32% of the high-risk group (p = 0.004). Using CHA(2)DS(2)-VASc, LA thrombus was found in 1.7% of the low-intermediate-risk group and 6.5% of the high-risk group (p = 0.053). SEC was found in 11.8% of the low-intermediate-risk group versus 30.9% of the high-risk group (p = 0.004). The sensitivity for LA thrombus/SEC with a high CHADS(2) and CHA(2)DS(2)-VASc score was 64.8% and 88.7%, respectively (p = 0.0001). The specificity for LA thrombus/SEC with high CHADS(2) and CHA(2)DS(2)-VASc scores was 52.6% and 28.9%, respectively (p = 0.0001). In conclusion, both CHA(2)DS(2)-VASc and CHADS(2) scores are useful for stroke risk stratification in patients with atrial flutter. CHA(2)DS(2)-VASc had greater sensitivity for LA thrombus and SEC detection at the cost of reduced specificity.

CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

The CHA(2)DS(2)-VASc score was developed to improve stroke risk stratification in atrial fibrillation (AF) patients. We sought to analyze the distribution and prognostic value of the CHA(2)DS(2)-VASc score in a cohort of ischemic stroke patients with AF. In total, 439 consecutive stroke patients with AF were studied. The CHA(2)DS(2)-VASc score was calculated according to clinical status before stroke onset. Poor outcome was defined as a modified Rankin score of 3 to 6 at 3months. Association between CHA(2)DS(2)-VASc score and poor outcome was analyzed using logistic regression analysis. In 95.6% of patients, CHA(2)DS(2)-VASc was >1 and only 41.8% of those with previously diagnosed AF were using oral anticoagulation at the time of the stroke. Poor outcome was found in 53.1% of the patients. In univariate analysis age, female sex, current smoking, previous stroke, CHA(2)DS(2)-VASc score, and stroke severity were associated with outcome. In multivariate analysis, CHA(2)DS(2)-VASc score was independently associated with poor outcome [OR 1.36 (95% CI: 1.14-1.62), P=0.001] as well as NIHSS [OR 1.22 (95% CI: 1.17-1.26), P<0.001]. After removing stroke severity, therapeutic anticoagulation was also associated with stroke prognosis [OR 0.45 (95% CI: 0.23-0.86), P=0.016]. Most patients with ischemic stroke and AF have a high CHA(2)DS(2)-VASc score. Independent of stroke severity, CHA(2)DS(2)-VASc score is associated with 3-month outcome. Despite all the available information and guidelines, our AF patients are clearly undertreated.

On the Formation of AlPO4-Based Molecular-Sieves in the Presence of Cyclohexylamine

The hydrothermal synthesis of the AlPO4-17, SAPO-44, MnAPSO-44 and intermediate solid phases [samples (APO)N, (APSO)N and Mn (APSO)N] in the presence of cyclohexylamine (cha) is described. (APO)N, (APSO)N and Mn (APSO)N represent unknown, layer-type, crystalline phases with different chemical compositions. These phases are predominantly formed at a high cha concentration and low crystallization temperature. All synthesized materials contain protonated cha in their structure, but only in AlPO4-17, (APO)N,(APSO)N and Mn (APSO)N is the -OH group also found. The calcination of the unknown phases leads to the loss of crystallinity and causes a complete breakdown of the crystal structure above 270°C.