Predicting thromboembolic events caused by left atrial appendage thrombosis (LAAT) is crucial since it is the most concerning complication of nonvalvular atrial fibrillation (NVAF). The objective of this study was to establish the predictive effectiveness of a novel scoring system known as the CLOTS-AF score in identifying the existence of thrombus using transesophageal echocardiography (TEE) in patients with NVAF and to compare it with the CHA₂DS₂-VASc score. This study was conducted retrospectively with 668 NVAF patients who underwent TEE in a single centre. The patients were categorized into two categories based on the presence or absence of LAAT on TEE. The CLOTS-AF score was computed for all patients, which was then compared to the CHA₂DS₂-VASc score. Thrombus was detected in the left atrial appendage (LAA) of 114 (17%) individuals. The study revealed that the thrombus (+) group had substantially higher CHA₂DS₂-VASc scores and CLOTS-AF scores (3 (2-4); 4 (3-6), p < .001), respectively. Furthermore, the CLOTS-AF score was shown to be a better predictor of LAAT than the CHA₂DS₂-VASc score (AUC: 0.70 vs. AUC: 0.61, p < .001). This study could validate the CLOTS-AF score in an external cohort by demonstrating its significant predictive power and underscoring its vital role in clinical practice.

Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis; however, early mortality risk stratification remains challenging. The Naples Prognostic Score (NPS), which integrates inflammatory and nutritional markers, has shown promise in cardiovascular disease prognosis. This study investigated the relationship between preprocedural NPS and 30-day mortality in patients undergoing TAVI. This retrospective, single-center study analyzed 308 patients aged ≥ 65 years who underwent elective transfemoral TAVI between August 2012 and December 2022. NPS was calculated using the neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, serum albumin, and total cholesterol levels. Patients were stratified into low NPS (0-2) and high NPS (3-4) groups. The primary endpoint was 30-day all-cause mortality. The mean age was 79.81 +- 7.68 years, and 54.9% patients were female. The high NPS group comprised 191 patients (62.0%), while 117 patients (38.0%) were in the low NPS group. Thirty-day mortality was significantly higher in patients with high NPS (16.8% vs. 4.3%, P < 0.001), representing nearly a four-fold increased risk. NPS demonstrated good discriminative ability for mortality prediction (area under the curve: 0.692, 95% confidence interval: 0.611-0.774, P < 0.001), performing comparably to established surgical risk scores. Independent predictors of mortality included age (odds ratio [OR] 1.067, P = 0.039), neutrophil-to-lymphocyte ratio (OR 1.062, P = 0.048), and pulmonary artery pressure (OR 1.039, P = 0.006). The Naples Prognostic Score is a significant predictor of early mortality following TAVI and offers a simple, readily available tool for preoperative risk stratification. Patients with high NPS may benefit from enhanced perioperative monitoring and targeted interventions.

Left atrial appendage thrombus (LAAT) is the predominant etiology of ischemic stroke in patients with atrial fibrillation (AF), and LAAT is optimally demonstrated by transesophageal echocardiography (TEE). The study aimed to assess patients with nonvalvular atrial fibrillation (NVAF) identified with thrombus using TEE compared to those without thrombus, utilizing the C-reactive protein/albumin ratio (CAR) as a sensitive biomarker. This study was conducted retrospectively at a single center with 668 patients with NVAF who underwent TEE. Patients were divided into two groups based on the presence or absence of LAAT on TEE. The levels of CAR, C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were compared. CAR was identified as an independent variable in patients with thrombus detected on TEE. (OR: 12.773, CI: 6.669-24.464, p < 0.001) Albumin was shown to have the highest area under the curve (AUC) value for thrombus prediction, followed by CAR, CRP, NLR, and PLR, in that order. (AUC: 0.999 CI: 0.993-1.000; 0.977 (0.962-0.987); 0.931 (0.909-0.949); 0.600 (0.562-0.937) p < 0.001, AUC: 0.574 CI: 0.535-0.612 p: 0.014). Our study demonstrates that CAR serves as an independent predictor of LAAT and shows more dependability than other biomarkers such as NLR, CRP, and PLR.

Post-myocardial infarction ventricular septal defect (PMIVSD) remains a lethal complication despite modern reperfusion. In patients with preserved or mildly reduced ejection fraction, higher shear across residual jets may increase the risk of device instability and hemolysis after transcatheter closure. A 48-year-old man presented with PMIVSD 15 days after chest pain. Echocardiography showed a left ventricular ejection fraction of 50% and a 13-mm apicoseptal defect. Surgery was advised but was declined. Percutaneous closure with an 18-mm muscular ventricular septal defect occluder via an arteriovenous loop was performed; however the device embolized to the right ventricular apex hours later. It was retrieved using a snared guidewire loop, and a 28-mm septal occluder was implanted. Severe intravascular hemolysis due to residual shunt developed, and despite intensive supportive therapy the patient died from septic shock. Surgery remains the preferred treatment for PMIVSD. In patients with preserved or mildly reduced ejection fraction, hyperdynamic ventricular mechanics and high left ventricular-right ventricular gradients increase risks of device embolization, residual shunt, and hemolysis after transcatheter closure. Surgical repair for PMIVSD should be prioritized when feasible; if transcatheter closure is pursued, stabilization, delayed timing, and careful device sizing are essential.