Background The first step in evaluating a patient with suspected stable coronary artery disease (CAD) is the determination of the pretest probability. The European Society of Cardiology guidelines recommend the use of the CAD Consortium 1 score (CAD1), which contrary to CAD Consortium 2 (CAD2) score and Duke Clinical Score (DCS), does not include modifiable cardiovascular risk factors. Hypothesis Using scores that include modifiable risk factors (DCS and CAD2) enhances prediction of CAD. Methods We retrospectively included all patients referred to invasive coronary angiography for suspected CAD from January/2008–December/2012 (N = 2234). Pretest probability was calculated using 3 models (CAD1, DCS, and CAD2), and they were compared using the net reclassification improvement. Results Mean patient age was 63.7 years, 67.5% were male, and the majority (66.9%) had typical angina. Coronary artery disease was diagnosed in 58.5%, and the area under the curve was 0.685 for DCS, 0.664 for CAD1, and 0.683 for CAD2, with a statistically significant difference between CAD1 and the others (P < 0.001). The net reclassification improvement was 20% for DCS, related to adequate reclassification of 32% of patients with CAD to a higher risk category, and 5% for CAD2, at the cost of adequate reclassification of 34% of patients without CAD to a lower risk category. Conclusions Prediction of CAD using scores that include modifiable cardiovascular risk factors seems to improve accuracy. Our results suggest that, in high‐prevalence populations, DCS may better identify patients at higher risk and CAD2 those at lower risk for CAD.

Vascular access site complications are frequent in patients undergoing TF TAVI. SIFAR was the only independent predictor of access site complications and therefore should be systematically assessed during pre-procedural imaging study.

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The majority of requests for transthoracic echocardiograms at a Portuguese tertiary care center were appropriate. Requests by cardiologists and outpatient referrals presented the highest rates of inappropriateness.

Self-expanding prosthesis have greater eccentricity and under-expansion. Calcium burden exerts more influence in the final morphology of that type of valve. Calcification and eccentricity are associated with the development of PVR. These factors should be considered in the selection of the most appropriate type of prosthesis for each scenario.

AV calcium volume was an independent predictor of PVR and BPD in patients submitted to TAVI. Our results support a systematic assessment of AV calcium volume to identify patients at increased risk of post-procedural PVR.

Acute hepatitis is a very rare, but potentially fatal, adverse effect of intravenous amiodarone. We present a case of an 88-year-old man with history of ischemic dilated cardiomyopathy and severely depressed left ventricular function that was admitted to our coronary care unit with diagnosis of decompensated heart failure and non-sustained ventricular tachycardia. A few hours after the beginning of intravenous amiodarone he developed an acute hepatitis. There was a completely recovery within the next days after amiodarone withdrawn and other causes of acute hepatitis have been ruled out. This case highlights the need for close monitoring of hepatic function during amiodarone infusion in order to identify any potential hepatotoxicity and prevent a fatal outcome. Oral amiodarone is, apparently, a safe option in these patients.

BackgroundPrevious studies showed that metabolic syndrome is associated with aortic valve calcification (AVC) and poor outcomes in aortic stenosis (AS). However, if these associations change and how body fat impacts the prognosis of patients in late stage of the disease have been not yet explored.AimsTo determine the association of body mass index (BMI) and visceral fat with AVC and mortality after transcatheter aortic valve replacement (TAVR).MethodsThis was a prospective cohort of 170 severe AS patients referred to TAVR. We quantified AVC mass score and fat depots including epicardial adipose tissue, intrathoracic fat, and abdominal visceral (VAF) and subcutaneous fats by computed tomography. Fat depots were indexed to body surface area. All-cause and cardiovascular-related deaths after TAVR were recorded over a median follow-up of 1.2 years.ResultsHigher AVC mass was independently associated with low BMI and low VAF. All-cause mortality risk increased with the decrease of BMI and increment of VAF. A stratified analysis by obesity showed that in non-obese, VAF was inversely associated with mortality, whereas in obese, high VAF was associated with higher mortality (p value for interaction < 0.05). At long-term, hazard ratio [HR] with non-obese/low VAF was 2.3 (95% confidence interval [CI] 1.1–4.9; p = 0.021) and HR with obese/high VAF was 2.5 (95% CI 1.1–5.8; p = 0.031) compared with obese/low VAF patients.ConclusionsIn AS patients submitted to TAVR, BMI and VAF were inversely associated with AVC. Pre-intervention assessment of VAF by computed tomography may provide a better discrimination of mortality than BMI alone.Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-017-0285-2) contains supplementary material, which is available to authorized users.