Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

AbstractBackground:Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge.Objectives:To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI.Methods:The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)].Results:The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05).Conclusions:In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.

Carlos Chagas Discoveries as a Drop Back to Scientific Construction of Chronic Chagas Heart Disease

Abstract The scientific construction of chronic Chagas heart disease (CCHD) started in 1910 when Carlos Chagas highlighted the presence of cardiac arrhythmia during physical examination of patients with chronic Chagas disease, and described a case of heart failure associated with myocardial inflammation and nests of parasites at autopsy. He described sudden cardiac death associated with arrhythmias in 1911, and its association with complete AV block detected by Jacquet's polygraph as Chagas reported in 1912. Chagas showed the presence of myocardial fibrosis underlying the clinical picture of CCHD in 1916, he presented a full characterization of the clinical aspects of CCHD in 1922. In 1928, Chagas detected fibrosis of the conductive system, and pointed out the presence of marked cardiomegaly at the chest X-Ray associated with minimal symptomatology. The use of serological reaction to diagnose CCHD was put into clinical practice in 1936, after Chagas' death, which along with the 12-lead ECG, revealed the epidemiological importance of CCHD in 1945. In 1953, the long period between initial infection and appearance of CCHD was established, whereas the annual incidence of CCHD from patients with the indeterminate form of the disease was established in 1956. The use of heart catheterization in 1965, exercise stress testing in 1973, Holter monitoring in 1975, Electrophysiologic testing in 1973, echocardiography in 1975, endomyocardial biopsy in 1981, and Magnetic Resonance Imaging in 1995, added to the fundamental clinical aspects of CCHD as described by Carlos Chagas.

Flora of Costa Rica ... by Paul C. Standley ...

v.18:pt:4(1938)

Flora of Costa Rica ... by Paul C. Standley ...

v.18:pt.3(1938)

Flora of Costa Rica ... by Paul C. Standley ...

v.18:pt.1(1937)

Flora of Costa Rica ... by Paul C. Standley ...

v.18:pt.2(1937)

New species of Digitaria, Pennisetum, and Poa (Gramineae) from Costa Rica / Richard W. Pohl.

v.38:no.2(1976)

Notes on the flora of Costa Rica, I / [by] William C. Burger.

v.31:no.11(1968)

Catalogue of a collection of birds from Costa Rica, by John Farwell Ferry.

v.1:no.6(1910)

Typification of Schlechter's Costa Rican Orchidaceae, types collected by A. Brenes / Kerry Barringer.

n.s. no.17(1986)

Nereididae (Annelida, Polychaeta) da costa nordeste do Brasil: II. Gêneros Namalycastis, Ceratocephale, Laeonereis e Rullierinereis

Six polychaete species belonging to the genera Namalycastis Hartman, 1959, Ceratocephale Malmgren, 1867, Laeonereis Hartman, 1945, and Rullierinereis Pettibone, 1970 were recorded as part of a systematic survey of the family Nereididae in estuaries, exposed sandy beaches, shelly soft bottoms, atolls and coral reefs of the Brazilian northeastern coast. Two new species, Rullierinereis auxiliadorae, from Ceará coast and Ceratocephale rocaensis, from Atol das Rocas, are described.

Two new beetles from Costa Rica and Australia, with a description of a new genus (Coleoptera, Cleridae) [by] Albert B. Wolcott and Henry S. Dybas.

v.31:no.18(1947)

Nereididae (Polychaeta) da costa nordeste do Brasil: III. Gêneros Ceratonereis e Nereis

Ten species belonging to the genera Ceratonereis Kinberg, 1866 and Nereis Linnaeus, 1758 were recorded in estuaries, exposed sandy beaches, shelly soft bottoms, atolls and coral reefs of the Brazilian northeastern coast. Two new species, Nereis serrata, from Ceará coast, and Nereis pseudomoniliformis, from Sergipe coast, are described.

Osteopatologias e alterações dentárias em Otaria byronia (Pinnipedia, Otariidae) da costa do Rio Grande do Sul, Brasil

Bone diseases and tooth alterations in 47 specimens of Otaria byronia (Blainville, 1820), from southern Brazilian coast, were analized. Tooth wear and the associated bone pathologies were determined, as well as their percentuals. The main infection was osteomyelitis associated with tooth alterations, such as fractures and attrition, both of them exposing the pulp chamber. Tooth attrition increases with age, favoring fractures and their complications, including osteomyelitis, causing a high frequency of them in specimens presenting more pronounced tooth wear. In one specimen tuberculosis was found in the maxilla, perhaps primarily pulmonary. The high frequency of enamel hypoplasia might reflect cyclic food deficit. Infections and tooth fractures might be related to behaviour, such as fishermen interaction, territorial fighting, and accidents during food capture.

Esponjas (Demospongiae, Halichondrida) da costa do Maranhão, Brasil

Three species of Halichondrida, Dragmacidon reticulatus (Ridley & Dendy, 1886) (Axinellidae), Myrmekioderma rea (Laubenfels, 1934) (Desmoxyidae) and Topsentia ophiraphidites (Laubenfels, 1934) (Halichondriidae), collected from 30 to 184 m depths, were recorded for the first time from State of Maranhão, north-northeast coast of Brazilian shelf.