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Background: Stress echocardiography today is a robust imaging modality used for diagnosing coronary artery disease (CAD). The CHA2DS2-VASc score is a validated risk score, its utility has been expanded beyond predicting the stroke risk in patients with atrial fibrillation to CAD prediction and risk assessment in many studies. We hypothesized that calculation of CHA2DS2-VASc score in cases with positive DSE for coronary ischemia may provide an incremental value in improving the diagnostic accuracy of DSE and predicting truly positive cases. Methods: Our cross-sectional study involved 60 patients who received positive DSE results for coronary ischemia and underwent subsequent coronary angiography, they were divided according to the presence of CAD as true positive and false positive groups. CHA2DS2⌐VASc score was calculated and correlated to the wall motion score index at peak stress and the presence of CAD. Results: We observed a significant association between CHA2DS2⌐VASc score ≥2 and the presence of CAD, p=0.001. Also, combining the WMSI at cut of >1.17 and CHA2DS VAS2C score ≥ 2 revealed a sensitivity of 80.5%, a specificity of 79%.and 80% accuracy and PPV of 89.2% for prediction of truly positive CAD in patients with positive DSE, Conclusions: We can conclude that the addition of the CHA2DS2⌐VAS2C score to the DSE positive model can improve the diagnostic accuracy of the test and its predictive value for true positive cases. [ABSTRACT FROM AUTHOR]

Background: Different strategies have been investigated for optimizing atrioventricular (AV) synchrony in patients with dual chamber pacemakers (DDD), which has a crucial role in preserving an effective cardiac output. To utilize the Left ventricular 2D speckle tracking strain parameters as a new tool guiding atrioventricular delay (AVD) synchronization in patients with DDD pacemaker to achieve the best LV systolic performance. Method: This interventional cross-over study involved 255 patients with DDD pacemakers, with mean age 50.62 ± 7.03 years, 175 of them were males 68.6% and 80 were females 31.4%. Each device was programmed to 4 different AV intervals, at one-week interval each; (AV pacing/AV sensing):120/100,150/130,180/160, 200/180 msec). Conventional echocardiographic parameters & left ventricular (LV) 2D speckle tracking (ST) strain were interrogated. Results: At relatively prolonged AVD (180/160 msec), both LV longitudinal strain and left ventricular outflow tract velocity time integral (LVOT VTI) were significantly improved (18.11±1.35 & 27.19 ± 3.16 respectively with P <0.001). Also, E/e showed the lowest values (8.5 ±2.9) and exercise time reached the best between (150/130 and 180/160 msec AVD;309±119 & 320±124, p <0.001 respectively). Conclusions: The benefit of LV speckle tracking based AV optimization looks to result from achieving the best LV systolic performance, this is a very important concern during AV synchronization in DDD pacemakers. [ABSTRACT FROM AUTHOR]