Background Oral anticoagulant drugs are proven to prevent thromboembolism in patients with atrial fibrillation (AF). To date, HAS‐BLED score is used to assess bleeding risk. This study was conducted to compare simplified HAS‐BLED (sHAS‐BLED) with conventional HAS‐BLED (cHAS‐BLED) scores. Methods This retrospective study recruited patients with AF receiving warfarin among July 2013 to December 2018 in Central Chest Institute of Thailand. The cHAS‐BLED score used the time in therapeutic range less than 70% as labile INR, whereas sHAS‐BLED score used SAMe‐TT2R2 score of 3 or more as a substitute for labile INR. A paired Student's t test was used to compare sHAS‐BLED and cHAS‐BLED. The Pearson's correlation was used to assess the correlation of sHAS‐BLED to cHAS‐BLED scores. The Bland‐Altman plot was used to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED score. Results A total of 126 AF patients were enrolled. The average age, SAMe‐TT2R2 score, and cHAS‐BLED score were 70.52 ± 10.37 years, 3.53 ± 1.03, and 2.03 ± 0.95, respectively. The sHAS‐BLED score was not statistically significantly different compared with cHAS‐BLED score (P = .08). The sHAS‐BLED and cHAS‐BLED scores had a very strong correlation with a correlation coefficient of .86 (P < .01). The Bland‐Altman plot was performed to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED scores. Conclusions The sHAS‐BLED was not statistically significantly different compared with cHAS‐BLED and can be used in clinical practice. However, larger clinical trial will be needed to prove whether sHAS‐BLED can predict bleeding risk in the future.

Background: To date, there has been no study that compares the efficacy and safety of warfarin in atrial fibrillation (AF) patients with Evaluated Heartvalves, Rheumatic

Background Several electrocardiographic (ECG) criteria are used to diagnose left ventricular hypertrophy (LVH); however, they have low sensitivity. Objective To assess the sensitivity of LVH diagnosis using Peguero–Lo Presti criteria modified by body surface area (BSA). Methods This study used retrospective data from 9,438 patients who attended the Central Chest Institute of Thailand from January 2017 to December 2017 with available echocardiography, and who were categorized into those with and without LVH to determine diagnostic accuracy. We randomly selected 317 patients after excluding others based on various conditions. The left ventricular mass of the 317 patients was estimated using echocardiography. Peguero–Lo Presti criteria were modified by dividing original criteria by BSA. The accuracy of the modified criteria was compared with that of the original Peguero–Lo Presti, Sokolow–Lyon, and Cornell voltage criteria. A McNemar test was used to determine the agreement of all ECG criteria examined with LV mass index. The area under a receiver operating characteristic curve (AUC) was used to assess the performance of the criteria. Results LVH was diagnosed in 164 of the 317 patients using echocardiography. The sensitivity of modified Peguero–Lo Presti criteria was 50.6% (95% confidence interval [CI] 42.7% to 58.5%), and specificity was 88.2% (95% CI 82.0% to 92.9%), with an AUC of 0.67 (95% CI 0.61–0.73). Conclusions Peguero–Lo Presti criteria modified by dividing them by BSA can improve sensitivity with acceptable specificity for the diagnosis of LVH compared with other ECG criteria examined, at least in selected Thai patients. The modified Peguero–Lo Presti criteria have accuracy similar to that for the original criteria.

Background Coronary angiography (CAG) or stress imaging has been performed in almost all Thai patients with left ventricular (LV) systolic dysfunction. If CAG results reveal insignificant coronary stenosis, such patients are diagnosed with nonischemic cardiomyopathy (NICM); however, CAG is considered to provide no benefit and may even harm these patients because it is invasive. Objectives To identify predictors associated with significant coronary artery disease (CAD) (stenosis) in Thai patients with LV systolic dysfunction without angina and without LV regional wall motion abnormality and create a prediction score. Method Retrospective data from patients at a single tertiary-care center with LV systolic dysfunction (LV ejection fraction <50%) diagnosed between August 2000 and October 2014 were separated into a group with ischemic cardiomyopathy (ICM) and a group with NICM according to CAG. Predictors associated with CAD found in normal populations were determined. Multivariate analysis was used to identify predictors associated with significant coronary stenosis in patients with LV systolic dysfunction to develop a model to create a prediction score. Results We included data registered from 240 Thai patients with LV systolic dysfunction. Predictors associated with ICM were age (>60 years), sex (male), and a history of diabetes mellitus (DM). Predictors associated with NICM were body mass index (BMI) >25 kg/m2 and the presence of left bundle branch block (LBBB) on electrocardiography. A simplified equation to predict significant CAD in patients with LV systolic dysfunction is: 3(male sex) + 3(age >60 y) – 5(BMI >25 kg/m2) - 5(LBBB) + 5(DM) - 5. The sensitivity and specificity of this score are 60.5% and 85.1%, respectively. Conclusion Our prediction score has modest sensitivity, but high specificity for predicting significant CAD and can be used to determine who should not undergo CAG.