Cancer and Infective endocarditis: diagnosis and prognostic impact. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

Abstract Background Little is known about the characteristics of infectious endocarditis (IE) in cancer patients, although their risk may be higher and their presentation non-specific. Purpose This study sought to assess the prevalence of cancer in patients with IE in the EURO-ENDO registry and to determine their baseline characteristics, management, outcomes in comparison to cancer-free patients with IE. Methods Data were collected from a prospective cohort of 3085 adult patients enrolled in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on the ESC 2015 diagnostic criteria. Clinical, biological, microbiological and echocardiographic findings, use of other imaging techniques, medical therapy, complications, theoretical indications for surgery, in-hospital mortality, and 1-year mortality were analysed in IE patients with and without cancer. Results 359 (11.6%) cancer patients with IE were identified and compared with 2726 IE patients without cancer. IE was community-acquired in 225/361 (74.8%), and more often nosocomial (18.6%) in healthcare associated cases. IE was native in 209 (60.4%), prosthetic in 97 (28%) and device-related in 30 (8.7%) patients. Microorganisms involved were Enterococci in 72/303 (23.8%), methicillin-sensitive Staphylococci in 63/303 (20.8%), and Streptococcus gallolyticus in 33/303 (10.9%) patients. IE cancer patients received more long-term cortico-therapy and immunosuppressive treatment compared to cancer free IE patients (9.1% vs. 3.9%, P<0.0001 and 11.7% vs. 2.7%, P<0.0001, respectively). Acute renal failure was the most frequent complication, observed in 25.9% of patients, followed by embolic events (21.7%). Congestive heart failure and cardiogenic shock occurred more frequently in cancer patients (18.1% vs. 13.4%, P=0.016; 10.1% vs. 6.3%, P=0.011, respectively). Cancer IE patients were more frequently treated with amoxicillin (35.8% vs. 26.3%; P=0.0002) and daptomycin (15.2% vs. 10.6%; P=0.0096), but less frequently treated with vancomycin (34.6% vs. 44.9%, P=0.0003). According to the ESC guidelines, theoretical indication for cardiac surgery was not significantly different between groups (65.5% vs. 69.8%, P=0.091), but was effectively less performed when indicated in cancer IE patients during hospitalisation (65.5% vs. 75.0%, P=0.0018). Compared to cancer-free IE patients, in-hospital and 1-year death occurred in 23.4% vs. 16.1%, P=0.006, and 35.7% vs. 23.1%, P<0.001, respectively. Predictors of mortality by multivariate analysis were creatinine >2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). Conclusion We report the largest contemporary series of patients with IE and cancer. The prevalence of cancer in IE patients is common and associated with a worse outcome. Patients with IE and cancer have different clinical characteristics than the general population and should require a specific management. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Pharmacological.

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Cancer and Infective Endocarditis: Characteristics and Prognostic Impact

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.766996 ◽

2021 ◽

Vol 8 ◽

Author(s):

Bernard Cosyns ◽

Bram Roosens ◽

Patrizio Lancellotti ◽

Cécile Laroche ◽

Raluca Dulgheru ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cardiac Surgery ◽

Cancer Patients ◽

Prognostic Impact ◽

Patients With Cancer ◽

Wide Range ◽

Observational Cohort ◽

Profile Management ◽

Baseline Characteristics

Background: The interplay between cancer and IE has become of increasing interest. This study sought to assess the prevalence, baseline characteristics, management, and outcomes of IE cancer patients in the ESC EORP EURO-ENDO registry.Methods: Three thousand and eighty-five patients with IE were identified based on the ESC 2015 criteria. Three hundred and fifty-nine (11.6%) IE cancer patients were compared to 2,726 (88.4%) cancer-free IE patients.Results: In cancer patients, IE was mostly community-acquired (74.8%). The most frequently identified microorganisms were S. aureus (25.4%) and Enterococci (23.8%). The most frequent complications were acute renal failure (25.9%), embolic events (21.7%) and congestive heart failure (18.1%). Theoretical indication for cardiac surgery was not significantly different between groups (65.5 vs. 69.8%, P = 0.091), but was effectively less performed when indicated in IE patients with cancer (65.5 vs. 75.0%, P = 0.002). Compared to cancer-free IE patients, in-hospital and 1-year mortality occurred in 23.4 vs. 16.1%, P = 0.006, and 18.0 vs. 10.2%; P < 0.001, respectively. In IE cancer patients, predictors of mortality by multivariate analysis were creatinine > 2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated).Conclusions: Cancer in IE patients is common and associated with a worse outcome. This large, observational cohort provides new insights concerning the contemporary profile, management, and clinical outcomes of IE cancer patients across a wide range of countries.

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Clinical characteristics and prognostic impact of pulmonary hypertension in heart failure with preserved ejection fraction: the PURSUIT HFpEF study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2286 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Sera ◽

T Ohtani ◽

K Nakamoto ◽

T Yamada ◽

Y Yasumura ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Ejection Fraction ◽

Right Atrial ◽

Rank Test ◽

Heart Catheterization ◽

Funding Source ◽

Prognostic Impact ◽

Preserved Ejection Fraction ◽

Private Company

Abstract Background Heart failure (HF) with preserved ejection fraction (HFpEF) can develop pulmonary hypertension (PH), which can result from pre-capillary PH as well as post-capillary PH. However, the prevalence and clinical significance of pre-capillary component of PH in HFpEF remain unknown. Purpose We aimed to investigate prevalence, clinical features, and prognostic impact of pre-capillary and/or post capillary PH associated with HFpEF. Methods From the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) registry, 204 patients (men: 46%, age: 79±9 years) who were hospitalized with HF and underwent right heart catheterization were divided into 4 groups according to the PH guidelines: non-PH, isolated post-capillary PH (Ipc-PH), pre-capillary PH, and combined pre- and post-capillary PH (Cpc-PH). Patients who had been diagnosed with idiopathic pulmonary arterial hypertension were excluded from the analysis. Results The prevalence of PH was 31% (Ipc-PH: 22%, pre-capillary PH: 3%, Cpc-PH: 6%). The prevalence of subcategories of PH was significantly different depending on mean right atrial pressure (RAP) (figure). Echocardiography at discharge showed no significant differences in RV diameter or TAPSE, but smaller LV diameter and higher E/e' in pre-capillary PH and Cpc-PH, which resulted in a higher operant diastolic elastance (Ed). Composite endpoint of all-cause mortality and HF hospitalization at 1 year occurred 13% in non-PH, 25% in Ipc-PH, 49% in pre-capillary PH, and 63% in Cpc-PH, respectively (p=0.001 by log-rank test). Conclusions Distinct prevalence of PH was observed in the groups with different RAP levels. Pre-capillary component of PH was associated with impaired LV diastolic function and worse outcomes in HFpEF. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Roche Diagnostics K.K.; Fuji Film Toyama Chemical Co. Ltd

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A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

European Heart Journal ◽

10.1093/ehjci/ehaa946.0960 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Jimenez ◽

M Cainzos-Achirica ◽

D Monterde ◽

L Garcia-Eroles ◽

C Enjuanes ◽

...

Keyword(s):

Heart Failure ◽

Chronic Conditions ◽

Temporal Trends ◽

Population Level ◽

Population Based ◽

Relative Increase ◽

Funding Source ◽

Private Company ◽

Healthcare Database ◽

Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

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Association of congestive heart failure with hospital outcomes among renal cancer patients in the United States: analysis of nationwide inpatient sample

Expert Review of Pharmacoeconomics & Outcomes Research ◽

10.1080/14737167.2021.1897576 ◽

2021 ◽

Author(s):

Sun-Kyeong Park ◽

Lindsay Park ◽

Ciara Silverman ◽

Ji-Haeng Heo ◽

Chanhyun Park

Keyword(s):

United States ◽

Heart Failure ◽

Congestive Heart Failure ◽

Cancer Patients ◽

Renal Cancer ◽

Nationwide Inpatient Sample ◽

The United States ◽

Hospital Outcomes

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Serum uric acid, influence of sacubitril/valsartan, and cardiovascular outcomes in heart failure with preserved ejection fraction: PARAGON-HF

European Heart Journal ◽

10.1093/ehjci/ehaa946.1066 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Selvaraj ◽

B.L Claggett ◽

D.V Veldhuisen ◽

I.S Anand ◽

B Pieske ◽

...

Keyword(s):

Heart Failure ◽

Uric Acid ◽

Ejection Fraction ◽

Serum Uric Acid ◽

Primary Outcome ◽

Adverse Outcomes ◽

Funding Source ◽

Preserved Ejection Fraction ◽

Private Company ◽

Increased Risk

Abstract Background Serum uric acid (SUA) is a biomarker of several pathobiologies relevant to the pathogenesis of heart failure with preserved ejection fraction (HFpEF), though by itself may also worsen outcomes. In HF with reduced EF, SUA is independently associated with adverse outcomes and sacubitril/valsartan reduces SUA compared to enalapril. These effects in HFpEF have not been delineated. Purpose To determine the prognostic value of SUA, relationship of change in SUA to quality of life and outcomes, and influence of sacubitril/valsartan on SUA in HFpEF. Methods We analyzed 4,795 participants from the Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction (PARAGON-HF) trial. We related baseline hyperuricemia to the primary outcome (CV death and total HF hospitalization), its components, myocardial infarction or stroke, and a renal composite outcome. At the 4-month visit, the relationship between SUA change and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS) and several biomarkers including N-terminal pro-B-type natriuretic peptide (NT-proBNP) were also assessed. We simultaneously adjusted for baseline and time-updated SUA to determine whether lowering SUA was associated with clinical benefit. Results Average age was 73±8 years and 52% were women. After multivariable adjustment, hyperuricemia was associated with increased risk for most outcomes (primary outcome HR 1.61, 95% CI 1.37, 1.90, Fig 1A). The treatment effect of sacubitril/valsartan for the primary outcome was not modified by baseline SUA (interaction p=0.11). Sacubitril/valsartan reduced SUA −0.38 mg/dL (95% CI: −0.45, −0.31) compared with valsartan (Fig 1B), with greater effect in those with baseline hyperuricemia (−0.50 mg/dL) (interaction p=0.013). Change in SUA was independently and inversely associated with change in KCCQ-OSS (p=0.019) and eGFR (p<0.001), but not NT-proBNP (p=0.52). Time-updated SUA was a stronger predictor of adverse outcomes over baseline SUA. Conclusions SUA independently predicts adverse outcomes in HFpEF. Sacubitril/valsartan significantly reduces SUA compared to valsartan, an effect that was stronger in those with higher baseline SUA, and reducing SUA was associated with improved outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

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Death, hospitalization, emergency department visits and out-patient visits in patients with heart failure in contemporary practice: results from the prospective Europeam 9069-patient ARIADNE registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1033 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L.H Lund ◽

U Zeymer ◽

A.L Clark ◽

V Barrios ◽

T Damy ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Primary Care Physicians ◽

Nyha Class ◽

Class Ii ◽

Emergency Department Visits ◽

Funding Source ◽

Office Visits ◽

Private Company ◽

Contemporary Practice

Abstract Background In Europe, heart failure (HF) is managed in variable settings and frequently in office-based practice. In HF with reduced ejection fraction (HFrEF) there is now extensive evidence based therapy, but implementation is inconsistent, variable and overall inadequate. The Assessment of Real lIfe cAre –Describing EuropeaN hEart failure management (ARIADNE) registry aimed to assess in detail how outpatients with HFrEF are managed in Europe in contemporary practice. Methods ARIADNE was a prospective non-interventional registry of patients with HFrEF (NYHA class II-IV) treated by office-based cardiologists or selected primary care physicians (recognized as HF specialists) in a real world setting. Patients were enrolled in 687 centres in 17 European countries, and studied at baseline and after 6 and 12 months. Key pre-specified outcomes were deaths, hospitalizations, emergency department visits, and office visits, and their primary reasons. Results Over 20 months, we enrolled 9069 patients; median age 69 (19–96) years, 24% women, with 30% older than 75 years, 61% NYHA class II, with a median EF 35% (30–40%). Over a median follow-up of 353 (1–631) days, 382 patients (4.3%) died, with 171 cardiovascular deaths (1.9%). The rates of total hospitalizations overall, for HF, and for non-HF cardiovascular reasons were 19.3, 8.1, and 4.8 per 100 patient years, respectively; and rates of emergency department visits overall, for HF reasons, and for non-HF CV reason were 7.7, 1.6, and 1.8, respectively. The number of HF office visits were on average 1.0 per patient. Conclusions In this large multinational HFrEF registry with detailed data on cause-specific outcomes and health care utilization, incidence of death was low and outpatient HF visits were few, but incidence of HF and CV hospitalization and emergency department visits was high. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis AG, Switzerland

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Early Surgical Intervention for Infective Endocarditis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000403 ◽

2002 ◽

Vol 10 (4) ◽

pp. 298-301 ◽

Cited By ~ 1

Author(s):

Hong Sheng Zhu ◽

Pei Yan Yao ◽

Jia Hao Zheng ◽

A Thomas Pezzella

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Heart Disease ◽

Infective Endocarditis ◽

Complex Disease ◽

Surgical Intervention ◽

Elective Surgery ◽

Postoperative Bleeding ◽

Arterial Embolization ◽

Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

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