CHADS2 and CHA2DS2VASc scores as predictors of cardioembolic sources in secondary stroke prevention | Revista Portuguesa de Cardiologia (English edition)

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The points indicate the cutoffs assuming equal importance for sensitivity and specificity and correspond to CHADS2 score ≥4 and CHA2DS2-VASc score ≥5." ] ] ] "textoCompleto" => "IntroductionStroke is the second leading cause of death worldwide,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and has a particularly alarming prevalence in Portugal, where mortality from stroke is around 200/100 000 population, one of the highest in the European Union.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a>Anatomopathologically and pathophysiologically, strokes are classified as ischemic (80%) or hemorrhagic (20%).<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Ischemic stroke is divided according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) etiological classification into five categories: large-artery atherosclerosis, cardioembolism, small-artery occlusion, stroke of other determined etiology, and stroke of undetermined etiology.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>A cardioembolic etiology is attributed to 20–30% of cases of ischemic stroke.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Stroke risk is increased in a range of heart diseases, particularly atrial fibrillation (AF),<a class="elsevierStyleCrossRef" href="#bib0035">7</a> but the risk of recurrent ischemic stroke in AF is significantly reduced by anticoagulant drugs for primary and secondary prevention.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>The CHADS2 score<a class="elsevierStyleCrossRef" href="#bib0050">10</a> was developed to stratify the risk of cardioembolic stroke. Current guidelines relate CHADS2 score to the antithrombotic therapy to adopt<a class="elsevierStyleCrossRef" href="#bib0055">11</a> and more recently, a new cardioembolic risk score, CHA2DS2-VASc, was created to refine the previous classification, but although these two scores have been validated in a heterogeneous population of AF patients for primary prevention,<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> their accuracy has not been ascertained for secondary stroke prevention.Transesophageal echocardiography (TEE) is an invasive exam that provides good anatomical information on the aortic arch, left atrium, left atrial appendage, and the mitral and aortic valves. It has high sensitivity and specificity for detecting cardioembolic sources, and is three times more accurate for this purpose than transthoracic echocardiography.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>The aim of this study was to analyze the possible correlation between the CHADS2 and CHA2DS2-VASc stroke risk scores and the presence of cardioembolic sources documented by TEE in patients with ischemic stroke.MethodsPopulationWe included all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE to investigate cardioembolic sources between January and August 2011.TEE was performed up to five days after the vascular event in the cardiology ward of the same hospital using a GE Vivid 7 Dimension scanner with a 6Tc RS multiplane transesophageal probe. The presence of a cardioembolic source was defined as the observation on TEE of thrombi in the left cardiac chambers or spontaneous echo contrast in the left atrium and atrial appendage.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Clinical variables (including hypertension, diabetes, coronary disease, congestive heart failure, smoking, dyslipidemia, personal history of stroke and alcohol abuse), demographic characteristics (age and gender), and laboratory results were obtained from patients’ medical records. The diagnosis of AF was based on direct observation of the relevant diagnostic exams. The efficacy of anticoagulation in previously anticoagulated patients (10; 10.6%) was assessed by the international normalized ratio (INR) on the date of the TEE study (±72 h).All patients were classified according to the CHADS2<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and CHA2DS2-VASc<a class="elsevierStyleCrossRef" href="#bib0080">16</a> risk scores and were compared in terms of clinical and demographic variables and cardiovascular risk in order to analyze the possible correlation with the presence of cardioembolic sources.Finally, we assessed the cutoffs, sensitivity, specificity and positive and negative predictive value of the two stroke risk scores as predictors of cardioembolic risk.Statistical analysisIBM SPSS Statistics version 20 was used for the statistical analysis.A descriptive analysis was performed, calculating means and standard deviation for quantitative variables and frequencies and percentages for qualitative variables.Demographic variables and prevalence of vascular risk factors were compared between patients with and without a cardioembolic source, using the chi-square test or Fisher's exact test as appropriate for qualitative variables and the Student's t test for quantitative variables.The different stroke scores and the date of TEE study were compared with the presence or absence of a cardioembolic source documented by TEE, using the Mann–Whitney U test for two independent variables.Receiver operator characteristic (ROC) curves were constructed to determine the cutoffs to predict a cardioembolic source in the total population, assuming equal importance for sensitivity and specificity for each of the risk scores used. This analysis was then repeated for the subgroup of non-anticoagulated patients to assess the robustness of the results.The level of statistical significance was set at p<0.05.ResultsPopulationDuring the study period 313 patients were diagnosed with ischemic cerebrovascular events (stroke or transient ischemic attack). Of these, 94 (30.0%) with a diagnosis of AF underwent TEE study. AF had been diagnosed prior to admission in 66 (70.2%), during hospital stay in 25 (26.6%) and after discharge in 3 (3.2%). A cardioembolic source was identified in 20 patients (21.3%), detected by spontaneous echo contrast in the left cardiac chambers in 19 (20.2%), thrombi in the left cardiac chambers in one (1.1%) and both in eight (8.5%).<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics, vascular risk factors and echocardiographic findings of the study population.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>At discharge 91 patients (96.8%) were under anticoagulant therapy, which was contraindicated in the other three (3.2%).Cardioembolic risk and TEE<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the comparison between the CHADS2 and CHA2DS2-VASc scores and the presence or absence of a cardioembolic source documented by TEE.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Analysis of sensitivity and specificity of the two stroke risk scoresAnalysis of the sensitivity, specificity and positive and negative predictive value of the CHADS2 and CHA2DS2-VASc risk scores is presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>. <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the results of the ROC curve analysis applied to the subgroup of non-anticoagulated patients (n = 84).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThe main aim of the present study was to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources in a population with ischemic stroke.The results show that age is a major factor in the presence of cardioembolism, which is in agreement with other studies<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and reflects the increased importance of this factor in the more recent CHA2DS2-VASc score. No significant association was found between the other risk and demographic factors assessed and the presence of a cardioembolic source, which is also in line with previous studies.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Mean INR values in previously anticoagulated patients were at subtherapeutic levels. There was no significant difference between those with and without a cardioembolic source; this should be interpreted with caution given the small number of patients treated with vitamin K antagonists, but it is a reminder of the need to maintain optimal dosages.The variables used in this study to predict a cardioembolic source have been confirmed by various authors<a class="elsevierStyleCrossRefs" href="#bib0075">15,19,20</a> to be effective in AF patients. Although TEE is the best exam due to its ability to detect spontaneous contrast in the left atrium, in the light of current indications for anticoagulation therapy its routine use is not recommended for AF patients in the European Society of Cardiology guidelines, which reserve it for particular situations.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> However, in the acute phase of stroke, the attending physician often needs reliable information on cardioembolic risk in order to determine the timing of antithrombotic therapy, and for such decisions TEE findings can be crucial, even in patients previously diagnosed with AF.Analysis of the CHADS2 and CHA2DS2-VASc scores in this study shows that this population is at moderate or high risk for stroke recurrence,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> which is to be expected.The findings of the study clearly confirm the validity of both of these scores in classifying risk even in secondary stroke prevention. However, analysis of their sensitivity and specificity reveals differences, the more recent classification showing greater sensitivity in predicting a cardioembolic source but lower specificity than the earlier system. No differences were seen in positive or negative predictive value.Various studies have shown that vitamin K antagonists are effective for primary and secondary stroke prevention, but they are also associated with bleeding complications and a significant percentage of patients discontinuing therapy.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> These disadvantages are among the reasons for the poor adherence to international guidelines for prevention of thromboembolic events.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> However, the development of new drugs that show equal or superior efficacy to warfarin in stroke prevention but with lower bleeding risk and without the need for regular laboratory testing<a class="elsevierStyleCrossRefs" href="#bib0125">25–28</a> has changed the risk/benefit ratio of prophylactic antithrombotic therapy in AF. It is now necessary to rethink the cutoffs for prescribing anticoagulation, and this requires risk scores with greater sensitivity in predicting ischemic events. The characteristics of the CHA2DS2-VASc scoring system as demonstrated in this study appear to indicate that it is more suitable for this task.Study limitationsThe main limitations of this study are the fact that it was based on a single center and that TEE was not performed immediately after the vascular event, which raises the possibility that previously existing thrombi were not visualized by the exam. Furthermore, the frequently paroxysmal nature of AF means that the absence of a cardioembolic source at a particular time does not exclude its existence previously or subsequently.ConclusionsThe findings of this study clearly confirm the validity of the CHADS2 and CHA2DS2-VASc scores in predicting cardioembolic risk in secondary stroke prevention. The more recent score, CHA2DS2-VASc, appears to be superior to the earlier scoring system, since the availability of new therapeutic approaches means that its slightly lower specificity is unlikely to compromise informed and individualized decision-making, and this is clearly outweighed by its higher sensitivity.Ethical disclosuresProtection of human and animal subjectsThe authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).Confidentiality of dataThe authors declare that no patient data appear in this article.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres251856" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and Objectives" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec239454" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres251855" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução e objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec239455" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Population" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Cardioembolic risk and TEE" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Analysis of sensitivity and specificity of the two stroke risk scores" ] ] ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Study limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-07-02" "fechaAceptado" => "2012-09-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec239454" "palabras" => array:5 [ 0 => "Stroke" 1 => "Atrial fibrillation" 2 => "Thromboembolism" 3 => "Echocardiography" 4 => "Anticoagulation" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec239455" "palabras" => array:5 [ 0 => "Acidente vascular cerebral" 1 => "Fibrilhação auricular" 2 => "Tromboembolismo" 3 => "Ecocardiografia" 4 => "Anticoagulação" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectivesCardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20–30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke. MethodsThe CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011.The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers. ResultsWe studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009). ConclusionsBoth scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosA cardioembolia representa uma das causas mais frequentes de lesões cerebrovasculares isquémicas, com prevalência estimada de 20-30% e implicações terapêuticas diretas que obrigam à sua correta avaliação. Apesar de a validação das escalas de risco cardioembólico (CHADS2 e, mais recentemente, CHA2DS2-VASc) em populações heterogéneas de doentes com fibrilhação furicular, desconhece-se ainda a sua validade em contexto de prevenção secundária cerebrovascular.É objetivo deste trabalho estudar a sensibilidade e especificidade diferencial das escalas de risco cardioembólico como preditoras de fonte cardioembólica documentada por ecocardiograma transesofágico (ETE) numa população de doentes com AVC isquémico. MétodosAplicámos as escalas CHADS2 e CHA2DS2-VASc a todos os doentes internados por evento cerebrovascular isquémico na Unidade de AVC/Enfermaria de Neurologia de um hospital central português com diagnóstico de fibrilhação auricular (prévio ou obtido durante/após o internamento), que realizaram ETE entre janeiro e agosto de 2011.Definimos como presença de fonte cardioembólica a observação em ETE de autocontraste espontâneo na aurícula e apêndice auricular esquerdo ou trombos nas cavidades cardíacas esquerdas. ResultadosAnalisámos 94 doentes, 66,0% do sexo masculino, idade média: 64,4 anos (desvio padrão: 14,2). Foi detetada fonte cardioembólica em 20 doentes. A análise de curva Receiver Operating Characteristic (ROC) identifica como preditores de fonte cardioembólica pontuação CHADS2 ≥ 4; sensibilidade: 75,0%, especificidade: 66,0%, p = 0,014 e pontuação CHA2DS2-VASc ≥ 5; sensibilidade: 83,3%, especificidade: 58,0%, p = 0,009. ConclusõesAmbas as escalas apresentam sensibilidade significativa como preditoras de risco cardioembólico em contexto de prevenção secundária cerebrovascular. A escala CHA2DS2-VASc possui uma sensibilidade superior à CHADS2, sendo, no entanto, menos específica." ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "The first two authors contributed equally to this work." "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Sá T, et al. CHADS2 e CHA2DS2VASc como preditores de fonte cardioembólica em prevenção secundária cerebrovascular. Rev Port Cardiol. 2013. http://dx.doi.org/10.1016/j.repc.2012.09.007." ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "Abbreviations" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:9 [ 0 => array:2 [ "termino" => "AF" "descripcion" => "atrial fibrillation" ] 1 => array:2 [ "termino" => "AUC" "descripcion" => "area under the curve" ] 2 => array:2 [ "termino" => "CI" "descripcion" => "confidence interval" ] 3 => array:2 [ "termino" => "ECG" "descripcion" => "electrocardiogram" ] 4 => array:2 [ "termino" => "INR" "descripcion" => "international normalized ratio" ] 5 => array:2 [ "termino" => "PFO" "descripcion" => "patent foramen ovale" ] 6 => array:2 [ "termino" => "ROC" "descripcion" => "receiver operating characteristic" ] 7 => array:2 [ "termino" => "TEE" "descripcion" => "transesophageal echocardiography" ] 8 => array:2 [ "termino" => "TOAST" "descripcion" => "Trial of Org 10172 in Acute Stroke Treatment" ] ] ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2049 "Ancho" => 1618 "Tamanyo" => 102692 ] ] "descripcion" => array:1 [ "en" => "ROC curve analysis of sensitivity and specificity of the CHADS2 and CHA2DS2-VASc risk scores. The points indicate the cutoffs assuming equal importance for sensitivity and specificity and correspond to CHADS2 score ≥4 and CHA2DS2-VASc score ≥5." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "ASD: atrial septal defect; INR: international normalized ratio; PFO: patent foramen ovale; TEE: transesophageal echocardiography." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total population \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Absence of cardioembolic source(n = 74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Presence of cardioembolic source(n = 20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.4 ± 14.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.3 ± 14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.7 ± 5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 (66.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 (76.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (65.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.919 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol abuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (9.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (8.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (15.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.364 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Personal history of stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (6.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.337 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coronary disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (11.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (13.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.439 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (9.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (10.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.666 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (31.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (33.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.421 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (55.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (52.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (65.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.326 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congestive heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.224 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (13.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (14.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atheromatous plaques in the thoracic aorta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (34.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (32.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (40.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.345 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (8.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (9.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.402 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valve vegetations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (6.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.377 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (4.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.484 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valve disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (17.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (13.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (30.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.808 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ventricular dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.209 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Date of TEE<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2 ± 1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1 ± 1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 ± 0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.391 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.91 ±0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.95 ± 0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.85 ± 0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.752 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355090.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "No. of days after the vascular event. INR values only for anticoagulated patients. Continuous variables are presented as means ± standard deviation and qualitative variables as frequencies and percentages." ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of vascular risk factors in the study population." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Scores are presented as medians (interquartile range)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Absence of cardioembolic source \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Presence of cardioembolic source \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHADS2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00 (3.00–4.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.00 (3.25–4.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00 (3.00–4.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2-VASc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.00 (3.00–5.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.00 (5.00–6.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.50 (3.00–5.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355089.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison between the two stroke risk scores and presence or absence of a cardioembolic source." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AUC: area under the curve; CI: confidence interval; NPV: negative predictive value; PPV: positive predictive value." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cutoff \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Specificity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">NPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">AUC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHADS2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.720 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.587–0.872 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2-VASc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.746 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.617–0.874 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355092.png" ] ] ] ] "descripcion" => array:1 [ "en" => "ROC curve analysis for the two stroke risk scores." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AUC: area under the curve; CI: confidence interval; NPV: negative predictive value; PPV: positive predictive value." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cutoff \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Specificity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">NPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">AUC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHADS2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.746 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.579–0.913 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2-VASc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.790 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.642–0.937 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355091.png" ] ] ] ] "descripcion" => array:1 [ "en" => "ROC curve analysis for the two stroke risk scores in non-anticoagulated patients only (n = 84)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and risk factors of cerebral ischemia and ischemic heart diseases: similarities and differences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.P. Soler" 1 => "V.C. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/157340310791658785" "Revista" => array:6 [ "tituloSerie" => "Curr Cardiol Rev" "fecha" => "2010" "volumen" => "6" "paginaInicial" => "138" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21804773" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective community-based study of stroke in Northern Portugal: incidence and case fatality in rural and urban populations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Correia" 1 => "M.R. Silva" 2 => "I. 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Original article

CHADS2 and CHA2DS2VASc scores as predictors of cardioembolic sources in secondary stroke prevention

CHADS2 e CHA2DS2VASc como preditores de fonte cardioembólica em prevenção secundária cerebrovascular

Tiago Sáa,b,1, João Sargento-Freitasb,1,

Corresponding author

jsargentof@hotmail.com

Corresponding author.

, Vítor Pinheiroa,b, Rui Martinsc, Rogério Teixeirac, Fernando Silvab, Nuno Mendonçab, Gustavo Cordeirob, Lino Gonçalvesc, Luís A. Providênciac, António Freire-Gonçalvesb, Luís Cunhab

a Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal

b Unidade de Acidentes Vasculares Cerebrais, Serviço de Neurologia, Centro Hospitalar Universitário de Coimbra, Hospitais da Universidade de Coimbra, Coimbra, Portugal

c Serviço de Cardiologia, Centro Hospitalar Universitário de Coimbra, Hospitais da Universidade de Coimbra, Coimbra, Portugal

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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ROC curve analysis of sensitivity and specificity of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc risk scores&#46; The points indicate the cutoffs assuming equal importance for sensitivity and specificity and correspond to CHADS<span class="elsevierStyleInf">2</span> score &#8805;4 and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;5&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0050" class="elsevierStylePara elsevierViewall">Stroke is the second leading cause of death worldwide&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and has a particularly alarming prevalence in Portugal&#44; where mortality from stroke is around 200&#47;100 000 population&#44; one of the highest in the European Union&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Anatomopathologically and pathophysiologically&#44; strokes are classified as ischemic &#40;80&#37;&#41; or hemorrhagic &#40;20&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Ischemic stroke is divided according to the TOAST &#40;Trial of Org 10172 in Acute Stroke Treatment&#41; etiological classification into five categories&#58; large-artery atherosclerosis&#44; cardioembolism&#44; small-artery occlusion&#44; stroke of other determined etiology&#44; and stroke of undetermined etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A cardioembolic etiology is attributed to 20&#8211;30&#37; of cases of ischemic stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Stroke risk is increased in a range of heart diseases&#44; particularly atrial fibrillation &#40;AF&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> but the risk of recurrent ischemic stroke in AF is significantly reduced by anticoagulant drugs for primary and secondary prevention&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The CHADS<span class="elsevierStyleInf">2</span> score<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> was developed to stratify the risk of cardioembolic stroke&#46; Current guidelines relate CHADS<span class="elsevierStyleInf">2</span> score to the antithrombotic therapy to adopt<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and more recently&#44; a new cardioembolic risk score&#44; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#44; was created to refine the previous classification&#44; but although these two scores have been validated in a heterogeneous population of AF patients for primary prevention&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> their accuracy has not been ascertained for secondary stroke prevention&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Transesophageal echocardiography &#40;TEE&#41; is an invasive exam that provides good anatomical information on the aortic arch&#44; left atrium&#44; left atrial appendage&#44; and the mitral and aortic valves&#46; It has high sensitivity and specificity for detecting cardioembolic sources&#44; and is three times more accurate for this purpose than transthoracic echocardiography&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The aim of this study was to analyze the possible correlation between the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc stroke risk scores and the presence of cardioembolic sources documented by TEE in patients with ischemic stroke&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Population</span><p id="par0080" class="elsevierStylePara elsevierViewall">We included all patients admitted to the stroke unit&#47;neurology ward of a Portuguese tertiary hospital with atrial fibrillation &#40;diagnosed previously or during or after admission&#41; who underwent TEE to investigate cardioembolic sources between January and August 2011&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">TEE was performed up to five days after the vascular event in the cardiology ward of the same hospital using a GE Vivid 7 Dimension scanner with a 6Tc RS multiplane transesophageal probe&#46; The presence of a cardioembolic source was defined as the observation on TEE of thrombi in the left cardiac chambers or spontaneous echo contrast in the left atrium and atrial appendage&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Clinical variables &#40;including hypertension&#44; diabetes&#44; coronary disease&#44; congestive heart failure&#44; smoking&#44; dyslipidemia&#44; personal history of stroke and alcohol abuse&#41;&#44; demographic characteristics &#40;age and gender&#41;&#44; and laboratory results were obtained from patients&#8217; medical records&#46; The diagnosis of AF was based on direct observation of the relevant diagnostic exams&#46; The efficacy of anticoagulation in previously anticoagulated patients &#40;10&#59; 10&#46;6&#37;&#41; was assessed by the international normalized ratio &#40;INR&#41; on the date of the TEE study &#40;&#177;72 h&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">All patients were classified according to the CHADS<span class="elsevierStyleInf">2</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> risk scores and were compared in terms of clinical and demographic variables and cardiovascular risk in order to analyze the possible correlation with the presence of cardioembolic sources&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Finally&#44; we assessed the cutoffs&#44; sensitivity&#44; specificity and positive and negative predictive value of the two stroke risk scores as predictors of cardioembolic risk&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall">IBM SPSS Statistics version 20 was used for the statistical analysis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A descriptive analysis was performed&#44; calculating means and standard deviation for quantitative variables and frequencies and percentages for qualitative variables&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Demographic variables and prevalence of vascular risk factors were compared between patients with and without a cardioembolic source&#44; using the chi-square test or Fisher&#39;s exact test as appropriate for qualitative variables and the Student&#39;s t test for quantitative variables&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The different stroke scores and the date of TEE study were compared with the presence or absence of a cardioembolic source documented by TEE&#44; using the Mann&#8211;Whitney U test for two independent variables&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Receiver operator characteristic &#40;ROC&#41; curves were constructed to determine the cutoffs to predict a cardioembolic source in the total population&#44; assuming equal importance for sensitivity and specificity for each of the risk scores used&#46; This analysis was then repeated for the subgroup of non-anticoagulated patients to assess the robustness of the results&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The level of statistical significance was set at p&#60;0&#46;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Population</span><p id="par0135" class="elsevierStylePara elsevierViewall">During the study period 313 patients were diagnosed with ischemic cerebrovascular events &#40;stroke or transient ischemic attack&#41;&#46; Of these&#44; 94 &#40;30&#46;0&#37;&#41; with a diagnosis of AF underwent TEE study&#46; AF had been diagnosed prior to admission in 66 &#40;70&#46;2&#37;&#41;&#44; during hospital stay in 25 &#40;26&#46;6&#37;&#41; and after discharge in 3 &#40;3&#46;2&#37;&#41;&#46; A cardioembolic source was identified in 20 patients &#40;21&#46;3&#37;&#41;&#44; detected by spontaneous echo contrast in the left cardiac chambers in 19 &#40;20&#46;2&#37;&#41;&#44; thrombi in the left cardiac chambers in one &#40;1&#46;1&#37;&#41; and both in eight &#40;8&#46;5&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics&#44; vascular risk factors and echocardiographic findings of the study population&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">At discharge 91 patients &#40;96&#46;8&#37;&#41; were under anticoagulant therapy&#44; which was contraindicated in the other three &#40;3&#46;2&#37;&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cardioembolic risk and TEE</span><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the comparison between the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scores and the presence or absence of a cardioembolic source documented by TEE&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Analysis of sensitivity and specificity of the two stroke risk scores</span><p id="par0155" class="elsevierStylePara elsevierViewall">Analysis of the sensitivity&#44; specificity and positive and negative predictive value of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc risk scores is presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the results of the ROC curve analysis applied to the subgroup of non-anticoagulated patients &#40;n &#61; 84&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">The main aim of the present study was to assess the sensitivity and specificity of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc stroke risk scores as predictors of cardioembolic sources in a population with ischemic stroke&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The results show that age is a major factor in the presence of cardioembolism&#44; which is in agreement with other studies<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and reflects the increased importance of this factor in the more recent CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#46; No significant association was found between the other risk and demographic factors assessed and the presence of a cardioembolic source&#44; which is also in line with previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Mean INR values in previously anticoagulated patients were at subtherapeutic levels&#46; There was no significant difference between those with and without a cardioembolic source&#59; this should be interpreted with caution given the small number of patients treated with vitamin K antagonists&#44; but it is a reminder of the need to maintain optimal dosages&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The variables used in this study to predict a cardioembolic source have been confirmed by various authors<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;19&#44;20</span></a> to be effective in AF patients&#46; Although TEE is the best exam due to its ability to detect spontaneous contrast in the left atrium&#44; in the light of current indications for anticoagulation therapy its routine use is not recommended for AF patients in the European Society of Cardiology guidelines&#44; which reserve it for particular situations&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> However&#44; in the acute phase of stroke&#44; the attending physician often needs reliable information on cardioembolic risk in order to determine the timing of antithrombotic therapy&#44; and for such decisions TEE findings can be crucial&#44; even in patients previously diagnosed with AF&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Analysis of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scores in this study shows that this population is at moderate or high risk for stroke recurrence&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> which is to be expected&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The findings of the study clearly confirm the validity of both of these scores in classifying risk even in secondary stroke prevention&#46; However&#44; analysis of their sensitivity and specificity reveals differences&#44; the more recent classification showing greater sensitivity in predicting a cardioembolic source but lower specificity than the earlier system&#46; No differences were seen in positive or negative predictive value&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Various studies have shown that vitamin K antagonists are effective for primary and secondary stroke prevention&#44; but they are also associated with bleeding complications and a significant percentage of patients discontinuing therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> These disadvantages are among the reasons for the poor adherence to international guidelines for prevention of thromboembolic events&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> However&#44; the development of new drugs that show equal or superior efficacy to warfarin in stroke prevention but with lower bleeding risk and without the need for regular laboratory testing<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;28</span></a> has changed the risk&#47;benefit ratio of prophylactic antithrombotic therapy in AF&#46; It is now necessary to rethink the cutoffs for prescribing anticoagulation&#44; and this requires risk scores with greater sensitivity in predicting ischemic events&#46; The characteristics of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scoring system as demonstrated in this study appear to indicate that it is more suitable for this task&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study limitations</span><p id="par0190" class="elsevierStylePara elsevierViewall">The main limitations of this study are the fact that it was based on a single center and that TEE was not performed immediately after the vascular event&#44; which raises the possibility that previously existing thrombi were not visualized by the exam&#46; Furthermore&#44; the frequently paroxysmal nature of AF means that the absence of a cardioembolic source at a particular time does not exclude its existence previously or subsequently&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">The findings of this study clearly confirm the validity of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scores in predicting cardioembolic risk in secondary stroke prevention&#46; The more recent score&#44; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#44; appears to be superior to the earlier scoring system&#44; since the availability of new therapeutic approaches means that its slightly lower specificity is unlikely to compromise informed and individualized decision-making&#44; and this is clearly outweighed by its higher sensitivity&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Protection of human and animal subjects</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Confidentiality of data</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardioembolism is one of the most common causes of ischemic stroke&#44; with an estimated prevalence of 20&#8211;30&#37;&#44; and correct diagnosis is essential given the therapeutic implications&#46; Although stroke risk scores &#40;CHADS<span class="elsevierStyleInf">2</span> and more recently CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#41; have been validated in heterogeneous populations of patients with atrial fibrillation&#44; their accuracy has not been ascertained for secondary stroke prevention&#46; We set out to assess the sensitivity and specificity of the CHADS<span class="elsevierStyleInf">2</span> and CHA2DS<span class="elsevierStyleInf">2</span>-VASc stroke risk scores as predictors of cardioembolic sources&#44; documented by transesophageal echocardiography &#40;TEE&#41; in a population with ischemic stroke&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scores were applied to all patients admitted to the stroke unit&#47;neurology ward of a Portuguese tertiary hospital with atrial fibrillation &#40;diagnosed previously or during or after admission&#41; who underwent TEE between January and August 2011&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We studied 94 patients&#44; 66&#46;0&#37; male&#44; mean age 64&#46;4 years &#40;standard deviation 14&#46;2&#41;&#46; A cardioembolic source was detected in 20 patients&#46; ROC curve analysis identified as predictors of cardioembolic source CHADS2 score &#8805;4 &#40;sensitivity of 75&#46;0&#37;&#44; specificity of 66&#46;0&#37;&#44; p&#61;0&#46;014&#41; and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;5 &#40;sensitivity of 83&#46;3&#37;&#44; specificity of 58&#46;0&#37;&#44; p&#61;0&#46;009&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke&#46; The CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score has higher sensitivity than CHADS<span class="elsevierStyleInf">2</span> but lower specificity&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cardioembolia representa uma das causas mais frequentes de les&#245;es cerebrovasculares isqu&#233;micas&#44; com preval&#234;ncia estimada de 20-30&#37; e implica&#231;&#245;es terap&#234;uticas diretas que obrigam &#224; sua correta avalia&#231;&#227;o&#46; Apesar de a valida&#231;&#227;o das escalas de risco cardioemb&#243;lico &#40;CHADS<span class="elsevierStyleInf">2</span> e&#44; mais recentemente&#44; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#41; em popula&#231;&#245;es heterog&#233;neas de doentes com fibrilha&#231;&#227;o furicular&#44; desconhece-se ainda a sua validade em contexto de preven&#231;&#227;o secund&#225;ria cerebrovascular&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#201; objetivo deste trabalho estudar a sensibilidade e especificidade diferencial das escalas de risco cardioemb&#243;lico como preditoras de fonte cardioemb&#243;lica documentada por ecocardiograma transesof&#225;gico &#40;ETE&#41; numa popula&#231;&#227;o de doentes com AVC isqu&#233;mico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Aplic&#225;mos as escalas CHADS<span class="elsevierStyleInf">2</span> e CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc a todos os doentes internados por evento cerebrovascular isqu&#233;mico na Unidade de AVC&#47;Enfermaria de Neurologia de um hospital central portugu&#234;s com diagn&#243;stico de fibrilha&#231;&#227;o auricular &#40;pr&#233;vio ou obtido durante&#47;ap&#243;s o internamento&#41;&#44; que realizaram ETE entre janeiro e agosto de 2011&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Definimos como presen&#231;a de fonte cardioemb&#243;lica a observa&#231;&#227;o em ETE de autocontraste espont&#226;neo na aur&#237;cula e ap&#234;ndice auricular esquerdo ou trombos nas cavidades card&#237;acas esquerdas&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Analis&#225;mos 94 doentes&#44; 66&#44;0&#37; do sexo masculino&#44; idade m&#233;dia&#58; 64&#44;4 anos &#40;desvio padr&#227;o&#58; 14&#44;2&#41;&#46; Foi detetada fonte cardioemb&#243;lica em 20 doentes&#46; A an&#225;lise de curva <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41; identifica como preditores de fonte cardioemb&#243;lica pontua&#231;&#227;o CHADS<span class="elsevierStyleInf">2</span> &#8805; 4&#59; sensibilidade&#58; 75&#44;0&#37;&#44; especificidade&#58; 66&#44;0&#37;&#44; p &#61; 0&#44;014 e pontua&#231;&#227;o CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc &#8805; 5&#59; sensibilidade&#58; 83&#44;3&#37;&#44; especificidade&#58; 58&#44;0&#37;&#44; p &#61; 0&#44;009&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Ambas as escalas apresentam sensibilidade significativa como preditoras de risco cardioemb&#243;lico em contexto de preven&#231;&#227;o secund&#225;ria cerebrovascular&#46; A escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc possui uma sensibilidade superior &#224; CHADS<span class="elsevierStyleInf">2</span>&#44; sendo&#44; no entanto&#44; menos espec&#237;fica&#46;</p>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">The first two authors contributed equally to this work&#46;</p>"
        "identificador" => "fn0005"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; S&#225; T&#44; et al&#46; CHADS<span class="elsevierStyleInf">2</span> e CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc como preditores de fonte cardioemb&#243;lica em preven&#231;&#227;o secund&#225;ria cerebrovascular&#46; Rev Port Cardiol&#46; 2013&#46; <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1016/j.repc.2012.09.007">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;09&#46;007</span>&#46;</p>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">Abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:9 [
              0 => array:2 [
                "termino" => "AF"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">atrial fibrillation</p>"
              ]
              1 => array:2 [
                "termino" => "AUC"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">area under the curve</p>"
              ]
              2 => array:2 [
                "termino" => "CI"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">confidence interval</p>"
              ]
              3 => array:2 [
                "termino" => "ECG"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">electrocardiogram</p>"
              ]
              4 => array:2 [
                "termino" => "INR"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">international normalized ratio</p>"
              ]
              5 => array:2 [
                "termino" => "PFO"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">patent foramen ovale</p>"
              ]
              6 => array:2 [
                "termino" => "ROC"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">receiver operating characteristic</p>"
              ]
              7 => array:2 [
                "termino" => "TEE"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">transesophageal echocardiography</p>"
              ]
              8 => array:2 [
                "termino" => "TOAST"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Trial of Org 10172 in Acute Stroke Treatment</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2049
            "Ancho" => 1618
            "Tamanyo" => 102692
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ROC curve analysis of sensitivity and specificity of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc risk scores&#46; The points indicate the cutoffs assuming equal importance for sensitivity and specificity and correspond to CHADS<span class="elsevierStyleInf">2</span> score &#8805;4 and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;5&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; atrial septal defect&#59; INR&#58; international normalized ratio&#59; PFO&#58; patent foramen ovale&#59; TEE&#58; transesophageal echocardiography&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Absence of cardioembolic source&#40;n &#61; 74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Presence of cardioembolic source&#40;n &#61; 20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;4 &#177; 14&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;3 &#177; 14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;7 &#177; 5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;66&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;76&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;65&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;919&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcohol abuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;9&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;8&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;15&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Personal history of stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coronary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;13&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;9&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;10&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;666&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;31&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;33&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13 &#40;65&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;326&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congestive heart failure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Smoking&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13 &#40;13&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;14&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atheromatous plaques in the thoracic aorta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;40&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PFO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;402&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valve vegetations&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;10&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ASD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ventricular dysfunction&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Date of TEE<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;2 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;1 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;5 &#177; 0&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;391&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">INR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;91 &#177;0&#46;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;95 &#177; 0&#46;53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;85 &#177; 0&#46;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;752&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Scores are presented as medians &#40;interquartile range&#41;&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Absence of cardioembolic source&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Presence of cardioembolic source&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#46;00 &#40;3&#46;25&#8211;4&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Cutoff&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Specificity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">PPV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">NPV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">AUC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;746&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;617&#8211;0&#46;874&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Cutoff&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Specificity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&nbsp;\t\t\t\t\t\t\n
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                  """
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">ROC curve analysis for the two stroke risk scores in non-anticoagulated patients only &#40;n &#61; 84&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2012.09.011

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	17	4	21
2024 October	77	27	104
2024 September	63	24	87
2024 August	58	32	90
2024 July	59	25	84
2024 June	50	18	68
2024 May	70	23	93
2024 April	57	22	79
2024 March	64	26	90
2024 February	45	21	66
2024 January	58	35	93
2023 December	39	29	68
2023 November	66	36	102
2023 October	46	17	63
2023 September	39	33	72
2023 August	43	16	59
2023 July	40	9	49
2023 June	43	17	60
2023 May	55	33	88
2023 April	40	9	49
2023 March	57	24	81
2023 February	40	21	61
2023 January	47	21	68
2022 December	62	36	98
2022 November	62	36	98
2022 October	78	27	105
2022 September	62	54	116
2022 August	79	41	120
2022 July	85	46	131
2022 June	53	31	84
2022 May	55	36	91
2022 April	56	39	95
2022 March	50	44	94
2022 February	61	44	105
2022 January	54	23	77
2021 December	41	32	73
2021 November	49	34	83
2021 October	43	42	85
2021 September	32	31	63
2021 August	41	31	72
2021 July	24	21	45
2021 June	44	21	65
2021 May	52	40	92
2021 April	95	20	115
2021 March	90	24	114
2021 February	79	20	99
2021 January	57	21	78
2020 December	54	7	61
2020 November	49	17	66
2020 October	23	19	42
2020 September	66	8	74
2020 August	30	12	42
2020 July	57	10	67
2020 June	62	6	68
2020 May	50	12	62
2020 April	52	8	60
2020 March	59	15	74
2020 February	90	31	121
2020 January	31	6	37
2019 December	43	11	54
2019 November	42	11	53
2019 October	41	7	48
2019 September	63	15	78
2019 August	30	4	34
2019 July	36	8	44
2019 June	39	15	54
2019 May	49	10	59
2019 April	26	15	41
2019 March	90	9	99
2019 February	81	16	97
2019 January	77	15	92
2018 December	82	19	101
2018 November	48	4	52
2018 October	39	21	60
2018 September	33	15	48
2018 August	35	8	43
2018 July	29	6	35
2018 June	30	8	38
2018 May	42	12	54
2018 April	36	8	44
2018 March	45	8	53
2018 February	36	10	46
2018 January	20	7	27
2017 December	60	11	71
2017 November	48	15	63
2017 October	46	11	57
2017 September	47	15	62
2017 August	50	17	67
2017 July	39	13	52
2017 June	51	10	61
2017 May	47	8	55
2017 April	53	4	57
2017 March	72	43	115
2017 February	39	10	49
2017 January	40	2	42
2016 December	60	15	75
2016 November	33	14	47
2016 October	56	12	68
2016 September	42	13	55
2016 August	7	2	9
2016 July	24	9	33
2016 June	14	12	26
2016 May	14	8	22
2016 April	36	1	37
2016 March	49	17	66
2016 February	66	28	94
2016 January	61	14	75
2015 December	53	13	66
2015 November	64	14	78
2015 October	72	15	87
2015 September	67	12	79
2015 August	52	11	63
2015 July	36	6	42
2015 June	30	7	37
2015 May	45	8	53
2015 April	54	17	71
2015 March	52	14	66
2015 February	34	11	45
2015 January	54	10	64
2014 December	56	12	68
2014 November	47	10	57
2014 October	49	12	61
2014 September	38	13	51
2014 August	40	13	53
2014 July	43	20	63
2014 June	45	6	51
2014 May	42	8	50
2014 April	56	16	72
2014 March	62	18	80
2014 February	70	11	81
2014 January	64	28	92
2013 December	61	12	73
2013 November	72	20	92
2013 October	72	29	101
2013 September	63	27	90
2013 August	81	25	106
2013 July	86	35	121
2013 June	14	8	22

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