CHA[2]DS[2] -VASc score as a predictor of left atrial thrombus in patients with non-valvular atrial fibrillation

To investigate whether or not the CHA[2]DS[2] -VASc score predicts left atrial [LA] thrombus detected on pre-cardioversion transoesophageal echocardiography [TEE]. 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 CHA[2]DS[2] -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. 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 CHA[2]DS[2] -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 CHA[2]DS[2] -VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA[2]DS[2] -VASc scores. On multivariate logistic analysis, the CHA[2]DS[2] -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. A high CHA[2]DS[2] -VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF

Urinary methylmalonic acid in patients with acute myocardial infarction

To investigate urinary methylmalonic acid [uMMA] levels and their relationship with markers of myocyte necrosis and inflammation in patients with acute myocardial infarction [AMI]. The study participants consisted of 80 consecutive patients with AMI and 72 age- and sex-matched consecutive controls. Of the patients, 38 had ST segment elevation myocardial infarction [STEMI] and 42 had non-ST segment elevation. All patients with STEMI underwent fibrinolytic therapy. Routine laboratory tests included troponin-I, creatinine phosphokinase MB [CK-MB], high-sensitivity C-reactive protein [hs-CRP], vitamin B12, folate, homocysteine and methylmalonic acid analyses. uMMA measurements were made by a spectrophotometric method. uMMA levels were significantly higher in patients with AMI than in controls [10.1 vs. 5.2 mmol/mol creatinine, p < 0.001] and higher in patients with anterior MI compared to those with non-anterior MI [18.9 vs. 8.7 mmol/mol creatinine, p < 0.001]. In addition, uMMA levels were significantly higher in patients without successful reperfusion compared to those with successful reperfusion. In patients with STEMI, a strong positive association was found between urinary MMA and plasma hs-CRP levels [r = 0.81, p < 0.001], symptom duration [r = 0.91, p < 0.001] and wall motion score [r = 0.60, p = 0.006]. More importantly, a strong positive association was observed between uMMA and the size of myocardial infarction in patients without successful reperfusion [for CK-MB r = 0.81, p = 0.013; for wall motion score r = 0.82, p = 0.012]. uMMA levels were elevated in patients with AMI and, as such, may be a candidate biochemical indicator of larger infarct size and enhanced inflammation in patients with AMI

Relationship between P-wave dispersion and effective hemodialysis in chronic hemodialysis patients

To investigate whether or not P-wave dispersion [PWD] can be used as a good indicator of effective hemodialysis. The study included 35 patients [20 males, 15 females, mean age 61 +/- 10 years] who regularly received hemodialysis treatment for chronic renal failure. Following hemodialysis, the patients whose hemodynamic parameters were preserved and who reached dry body weight were included. Twelve-lead resting electrocardiogram [ECG] at a speed of 25-50 mm/s, the value of total body fluid [TBF] and bioelectric impedance using bipedal bioelectric impedance equipment were obtained before and immediately after hemodialysis. Blood samples were also taken for the assessment of blood electrolytes, urea and creatinine. PWD was defined as the difference between the maximum and minimum P-wave duration calculated on a standard 12-lead ECG before and after dialysis. The following parameters were obtained before and after hemodialysis: blood pressure 132 +/- 21 vs. 130 +/- 10 mm Hg [p > 0.05], TBF 33.9 +/- 6 vs. 32 +/- 5.6 liters [p = 0.001], impedance 499 +/- 110 vs. 596 +/- 136 omega [p = 0.001], P-max 103.1 +/- 8.9 vs. 106.3 +/- 12.7 ms [p > 0.05], P-min 70.2 +/- 11 vs. 72.5 +/- 7.9 ms [p > 0.05], PWD 32.2 +/- 11.9 vs. 33.8 +/- 13.4 ms [p > 0.05]. Although statistically significant decreases were observed in urea and creatinine levels after hemodialysis, no such changes were observed in blood electrolytes. The P-max and PWD did not change significantly after hemodialysis, hence these two parameters can be used as an indicator of effective hemodialysis