scholarly journals Characteristics and Outcomes In Patients With Left-Sided Infective Endocarditis Undergoing Left-Sided Valve Surgery With or Without Concomitant Tricuspid Annuloplasty

2021 ◽  
Author(s):  
Zexuan Wu ◽  
Yuanyuan Zhou ◽  
Yili Chen ◽  
Fangfei Wei ◽  
Zi Ye ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Postoperative Complications ◽  
Clinical Features ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Right Atrial ◽  
Average Hospital ◽  
Tricuspid Annuloplasty ◽  
Long Term Mortality

Abstract Background: In patients with left-sided infective endocarditis (LSIE) undergoing left-sided valve surgery (LVS), the effects of concomitant tricuspid annuloplasty (TA) on clinical features and prognosis remain unknown. Methods: This is a single-center retrospective study conducted in a tertiary hospital in China. A total of 207 consecutive patients ≥18 years with a definite LSIE diagnosis who underwent LVS between 2008 and 2017 were included. Patients were divided into two groups: LVS alone (n=157) and LVS+TA group (n=50), to identify differences between the clinical features, echocardiogdraphic parameters and outcomes.Results: The mean age was 44.6±15.6 years and 150 (72.5%) were male. Of the 207 patients, 71 (34.3%) patients had aortic valve involved alone, 115 (55.6%) had mitral valve involved alone and 21 (10.1%) had both valved involved. The average hospital stays were 38±16 days and the median follow-up duration was 34.4 (IQR 19.8-56.3) months. Demographic and baseline characteristics were comparable between the two groups, except that the renal function in LVS alone group was better than LVS +TA group (eGFR 97.2±28.8 vs. 87.6±30.7, P=0.046). Significant reductions in left and right atrial diameter, left ventricular diameter, mitral and tricuspid regurgitation (TR) degree, and pulmonary arterial systolic pressure were reported in both groups, of which the differences were more prominent in LVS+ TA group than LVS alone group (P<0.05). The rate of postoperative complications was higher in LVS+ TA group than that in LVS group (44.0% vs. 23.6%, P=0.005). However, the in-hospital mortality and long-term mortality was similar in both groups. After multi-factor adjustment, concomitant TA was not significantly associated with in-hospital and long-term mortality.Conclusions: Concomitant TA at the time of LVS significantly improved cardiac diameter but increased postoperative complications. It might not be associated with improved survival in LSIE patients.

scholarly journals Age, creatinine and ejection fraction (ACEF) score: a simple risk-stratified method for infective endocarditis

QJM ◽  
2019 ◽  
Vol 112 (12) ◽  
pp. 900-906 ◽  
Author(s):  
X -B Wei ◽  
Z -D Su ◽  
Y -H Liu ◽  
Y Wang ◽  
J -L Huang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hospital Death ◽  
Ventricular Ejection Fraction ◽  
Long Term Mortality

Summary Background Older age, renal dysfunction and low left ventricular ejection fraction are accepted predictors of poor outcome in patients with infective endocarditis (IE). This study aimed to investigate the prognostic significance of the age, creatinine and ejection fraction (ACEF) score in IE. Methods The study involved 1019 IE patients, who were classified into three groups according to the tertiles of ACEF score: low ACEF (<0.6, n = 379), medium ACEF (0.6–0.8, n = 259) and high ACEF (>0.8, n = 381). The ACEF score was calculated as follows: age (years)/ejection fraction (%)+1 (if serum creatinine value was >2 mg/dL). The relationship between ACEF score and adverse events was analyzed. Results In-hospital mortality was 8.2%, which increased with the increase of ACEF score (4.2% vs. 5.0% vs. 14.4% for the low-, medium- and high-ACEF groups, respectively; P < 0.001). ACEF score had a good discriminative ability for predicting in-hospital death [areas under the curve (AUC), 0.706, P < 0.001]. The predictive value of ACEF score in surgical treatment was significantly higher than in conservative treatment for predicting in-hospital death (AUC, 0.812 vs. 0.625; P = 0.001). Multivariable analysis revealed that ACEF score was independently associated with in-hospital mortality (adjusted odds ratio, 2.82; P < 0.001) and long-term mortality (adjusted hazard ratio, 2.51; P < 0.001). Conclusion ACEF was an independent predictor for in-hospital and long-term mortality in IE patients, and it could be considered as a useful tool for risk stratification. ACEF score was more suitable for surgical patients in terms of assessing the risk of in-hospital mortality.

Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Eric Charbonneau ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Mortality

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.

scholarly journals 131 Cancer and takotsubo syndrome: clinical features, outcome, and inflammatory patterns. Results from a multicentre prospective registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Enrica Vitale ◽  
Francesco Santoro ◽  
Alessandra Leopizza ◽  
Adriana Mallardi ◽  
Massimo Iacoviello ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Clinical Features ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Patients With Cancer ◽  
History Of ◽  
Inflammatory Pattern ◽  
History Of Cancer ◽  
Long Term Mortality

Abstract Aims Cancer represents one of the major determinants of prognosis in patients with Takotsubo Syndrome (TTS). Aim of this study was therefore to compare clinical features, short- and long-term outcome and inflammatory pattern among TTS patients with history of cancer. Methods and results 412 consecutive patients with TTS were enrolled in a multicentre prospective registry from July 2007 to February 2021. Clinical features, in and out of hospital MACE, laboratory and imaging data were collected. A sub-analysis evaluating serum interleukins levels among 12 patients with cancer vs. a propensity score matched cohort was performed. Prevalence of history of cancer was 12% (N = 51 pts). Patients with history of cancer were older (77 vs. 72 years, P = 0.01), with a higher percentage of male (23.5% vs. 8.8%, P = 0.01). Diabetes, dyslipidemia, and obesity were more prevalent in patients with cancer (29% vs. 22%, 49% vs. 42%, 25.5% vs. 18.5%, P = 0.01 respectively), while a similar prevalence was found for hypertension and smoke. Left ventricular ejection fraction (LVEF) at admission and discharge was lower in patients with history of cancer (33% vs. 37%, 44% vs. 50%. P = 0.03 respectively). Patients with cancer showed higher incidence of in hospital events (41% vs. 33%, P = 0.01) mainly driven by cardiogenic shock (21.5% vs. 8.5% P = 0.01), in hospital death (13.7% vs. 4.7%, P = 0.01), left ventricular thrombi (9.8% vs. 3.3%, P = 0.01) and ventricular arrhythmias (13.7% vs. 7.4%, P = 0.01). The long-term mortality was higher in patients with history of cancer (31.3% vs. 11.3%, P = 0.01). A distinct inflammatory pattern was found in cancer patients: at admission there were higher levels of IL 2 and VEGF levels (IL-2 3.3 vs. 0.7 pg/ml, P = 0.05, VEGF 476.3 vs. 249.5 pg/ml, P = 0.03); at discharge IL-4 was lower (1.17 pg/ml vs. 2.49 pg/ml, P = 0.04) while VEGF remained higher in subjects with TTS and cancer (406 vs. 128 pg/ml, P = 0.03). Conclusions Cancer patients with TTS are characterized by different clinical features, epidemiological characteristics, worse prognosis and higher long-term mortality when compared to patients with TTS without history of malignancy. A distinct inflammatory pattern can be found in this subset of TTS patients.

Surgical technique does not influence the long term mortality after tricuspid valve surgery

2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
K.-W. Felkel ◽  
K. Kampmann ◽  
F. Hahnel ◽  
H. Reichenspurner ◽  
H. Gulbins
Keyword(s):  
Surgical Technique ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
Tricuspid Valve Surgery ◽  
Long Term Mortality

Sex differences in pharmacotherapy and long-term outcomes in patients with ischaemic heart disease and left ventricular dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Dagan ◽  
D Dinh ◽  
J Stehli ◽  
C Tan ◽  
A Brennan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Medical Therapy ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Kaplan Meier ◽  
Long Term Mortality

Abstract Background Left ventricular dysfunction and ischaemic heart disease are common amongst women, however, women tend to present later and are less likely to receive guideline-directed medical therapy compared to their male counterparts. Purpose To investigate if a sex discrepancy exists for optimal medical therapy (OMT) and long-term mortality in a cohort of patients with known ischaemic heart disease (IHD) and left ventricular dysfunction. Methods We analysed prospectively collected data from a multicentre registry database collected between 2005–2018 on pharmacotherapy 30-days post percutaneous coronary intervention (PCI) in 13,015 patients with left ventricular ejection fraction (LVEF) &lt;50%. OMT at 30-days was defined as beta-blocker (BB), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) ± mineralocorticoid receptor antagonist (MRA). Long-term mortality was determined by linkage with the National Death Index, with median follow up of 4.7 (IQR 2.0–8.6) years. Results Mean age was 65±12 years; women represented 20.2% (2,634) of the cohort. Women were on average 5 years older, had higher average BMI, higher rates of hypertension, diabetes, renal dysfunction, prior stroke and rheumatoid arthritis. Men were more likely to have sleep apnoea, be current/ex-smokers and to have had prior myocardial infarction, PCI and bypass surgery. Overall, 72.3% (9,411) of patients were on OMT, which was similar between sexes (72.7% in women vs. 72.2% in men, p=0.58). Rates of BB therapy were similar between sexes (85.2% vs. 84.5%, p=0.38), while women were less likely to be on an ACEi/ARB (80.4% vs. 82.4%, p=0.02) and more likely to be on a MRA (12.1% vs. 10.0%, p=0.003). Amongst those with LVEF ≤35% (n=1,652), BB (88.7% vs. 87.3%, p=0.46), ACEi/ARB (83.3% vs. 82.1%, p=0.59) and MRA use (32.5% vs. 33.3%, p=0.78) was comparable. Aspirin use was similar between sexes (95.3% vs. 95.9%, p=0.12), while women were less likely to be on statin therapy (93.5% vs. 95.3%, p&lt;0.001) and a second antiplatelet agent (94.4% vs. 95.6%, p=0.007). On unadjusted analysis women had significantly higher long-term mortality of 25.4% compared to 19.0% for men (p&lt;0.001). Kaplan-Meier analysis out to 14 years demonstrated that men on OMT have the best long-term survival overall and women on sub-OMT have significantly poorer outcomes compared to men on sub-OMT. However, after adjusting for OMT and other comorbidities there was no difference in long-term mortality between sexes (HR 0.99, 95% CI 0.87–1.14, p=0.94). Conclusion From this large multicentre registry, we found similar rates of guideline-directed pharmacotherapy for left ventricular dysfunction between sexes, however women were less likely to be on appropriate IHD secondary prevention. The increased unadjusted long-term mortality amongst women is likely due to differing baseline risk, given that adjusted mortality was similar between sexes. Kaplan-Meier Survival Analysis Funding Acknowledgement Type of funding source: None

Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients

2021 ◽  
Author(s):  
Emanuele Durante-Mangoni ◽  
Giuseppe Giuffrè ◽  
Maria Paola Ursi ◽  
Domenico Iossa ◽  
Lorenzo Bertolino ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Historical Cohort ◽  
Historical Cohort Study ◽  
Long Term Mortality
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