ABSTRACT
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.
Subject(s)
Atrial Appendage , Atrial Fibrillation/complications , Cardiac Imaging Techniques/methods , Stroke , Thromboembolism , Atrial Appendage/diagnostic imaging , Atrial Appendage/pathology , Humans , Risk Assessment/methods , Stroke/diagnosis , Stroke/etiology , Stroke/prevention & control , Thromboembolism/diagnosis , Thromboembolism/etiology , Thromboembolism/prevention & controlABSTRACT
Los tests de rendimiento son punteros en incorporar innovaciones psicométricas, necesarias para medir la concepción actual de rendimiento. Dicho concepto ha ido cambiando desde el conductismo, que defendía la medición de muestras de conducta observables, sin apenas referencias a procesos internos, hasta ahora, en que desde la Psicología Cognitiva y las corrientes educativas, se defiende la necesidad de explorar también los mecanismos internos que se ponen en funcionamiento ante una prueba de rendimiento. Se trata de intentar aproximarse a la estructura mental que el examinado tiene de un dominio de conocimiento determinado. La teoría de respuesta al ítem se ha convertido en el instrumento básico actual para escalar el conocimiento individual. Presentamos un estudio preliminar en el que calculamos las funciones de información de varios modelos de escalamiento, aplicados a la evaluación del conocimiento complejo. Nuestra aproximación utiliza el concepto de «mapa conceptual», usado en la evaluación propuesta por las nuevas corrientes educativas, pero intentando sustituir sus aspectos cualitativos por un escalamiento estandarizado parecido al de los tests tradicionales. Para ello utilizamos una escala graduada de respuesta, y analizamos las funciones de información de varios modelos politómicos, y uno dicotómico (modelo de dos parámetros), como línea base de comparación. Los resultados indican que el modelo de crédito parcial generalizado es adecuado para escalar el rendimiento entendido de esta forma (AU)
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