scholarly journals Cancer and Infective Endocarditis: Characteristics and Prognostic Impact

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.

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

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Cosyns ◽  
B Roosens ◽  
P Lancellotti ◽  
S Marchetta ◽  
V Scheggi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Surgery ◽  
Infective Endocarditis ◽  
Cancer Patients ◽  
Prospective Cohort ◽  
Funding Source ◽  
Prognostic Impact ◽  
Private Company ◽  
Prevalence Of Cancer

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.

scholarly journals Morbidity, Mortality and Costs Associated with Venous Thromboembolism in Hospitalized Patients with Cancer

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2613-2613
Author(s):  
Gary H. Lyman ◽  
Eva Culakova ◽  
Marek S. Poniewierski ◽  
Nicole M. Kuderer
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Infectious Complications ◽  
Hospitalized Patients ◽  
Patients With Cancer ◽  
Risk Of Mortality

Background: Venous thromboembolism (VTE) occurs commonly in patients with cancer and is associated with considerable morbidity and mortality. While the risk of VTE is greater in hospitalized patients and those undergoing active treatment, less is known about factors associated with increased risk of mortality and costs in this setting. The study presented here evaluates the risk of mortality among hospitalized cancer patients with VTE and the association of patient comorbidities and infectious complications on duration of hospitalization, in-hospital mortality and costs. Methods: Data on hospitalization of adult patients (age≥18) with cancer between 2004 and 2012 from 239 US academic medical centers reporting to the University Health Consortium were analyzed. For patients with multiple hospitalizations, the first admission during the time period studied was utilized. Primary outcomes consisted of length of stay, in-hospital mortality and estimated cost of hospitalization. Stratified analyses were performed based on patient characteristics, year of hospitalization, cancer type, major comorbidities and infectious complications. Costs were adjusted to 2014 dollars. Results: Among more than 3.8 million admissions of adult patients with cancer, 246,653 included a diagnostic code for VTE representing 198,173 individual patients with both cancer and VTE. Overall, 41% of patients with cancer and VTE were hospitalized for 10 days or longer with an in-hospital mortality rate of 11.3% and estimated average costs per hospitalization of $37,039. While length of stay and mortality rates remained relatively stable over the 9 years of observation, 2014-adjusted costs per day hospitalization increased from $2,600 in 2004 to $3,200 in 2012. In-hospital mortality was greatest in patients with lung (15.8%) and gastric (14.1%) cancers and leukemia (14.2%). Medical comorbidities associated with the highest rates of mortality included congestive heart failure (19.8%), cerebrovascular disease (20.4%), and major disorders of the lung (20.6%), liver (20.0%), and kidney (21.4%) with mortality increasing in direct proportion to the number of comorbidities. Likewise, comorbidities associated with the greatest average costs per hospitalization included congestive heart failure ($51,885), cerebrovascular disease ($55,815), and major disorders of the lung ($53,899), liver ($51,332), and kidney ($55,774) with estimated costs increasing from $22,622 with no medical comorbidity to over $70,000 with four or more. Alternatively, infectious complications associated with the highest rates of mortality and greatest average costs were sepsis (38.1%; $90,529) and pneumonia (26.0%; $69,024). Conclusions: Hospitalized patients with cancer and VTE are at considerable risk for prolonged hospitalization and in-patient mortality accompanied by considerable hospital costs. Patients with additional major comorbidities and infectious complications are at even greater risk of in-hospital mortality and substantially greater costs. Additional efforts to identify cancer patients at greater risk for VTE and its complications including prolonged hospitalization and in-hospital mortality are needed as well as better strategies and agents for reducing the risk and consequences of VTE. Disclosures Lyman: Amgen: Research Funding.

scholarly journals N-terminal B-type natriuretic peptide levels in pediatric patients with congestive heart failure undergoing cardiac surgery

2008 ◽  
Vol 135 (1) ◽  
pp. 98-105 ◽  
Author(s):  
Rowan Walsh ◽  
Clark Boyer ◽  
Jared LaCorte ◽  
Vincent Parnell ◽  
Cristina Sison ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Surgery ◽  
Natriuretic Peptide ◽  
Pediatric Patients

scholarly journals Prognostic Impact of Plasma N-Terminal Pro–Brain Natriuretic Peptide in Severe Chronic Congestive Heart Failure

Circulation ◽  
2004 ◽  
Vol 110 (13) ◽  
pp. 1780-1786 ◽  
Author(s):  
Franz Hartmann ◽  
Milton Packer ◽  
Andrew J.S. Coats ◽  
Michael B. Fowler ◽  
Henry Krum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Chronic Congestive Heart Failure ◽  
Prognostic Impact

Incidence and risk of congestive heart failure risk in renal cell cancer (RCC) and non-RCC patients treated with sunitinib.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 316-316 ◽  
Author(s):  
C. J. Richards ◽  
Y. Je ◽  
F. A. Schutz ◽  
S. M. Dallabrida ◽  
J. J. Moslehi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cancer Patients ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Cell Cancer ◽  
Tumor Type ◽  
High Grade ◽  
Increased Risk

316 Background: Sunitinib is a multitargeted receptor tyrosine kinase inhibitor that is widely used in the treatment of renal cell cancer (RCC) and several other malignancies. Congestive heart failure (CHF) has been reported with sunitinib, but the overall incidence and relative risk (RR) remain undefined. We preformed an up-to-date comprehensive meta-analysis to determine the risk of developing serious CHF in patients with both RCC and non-RCC tumors treated with sunitinib. Methods: Medline databases were searched for articles from January 1966 to September 2010. Eligible studies were limited to phase II and III trials of sunitinib in cancer patients with any primary tumor type and adequate safety profile reporting. Statistical analyses were conducted to calculate the summary incidence, RR and 95% confidence intervals (CI), using random-effects models. Results: A total of 5,497 patients were included. Overall incidence for all-grade and high-grade CHF in sunitinib-treated patients was 4.9% (95% CI, 1.6–14.1%) and 1.8% (95% CI, 0.8–3.9%), respectively. The RR of all-grade and high-grade CHF in sunitinib-treated patients compared to placebo-treated ones was 1.81 (95% CI, 1.30–2.50; p<0.0001) and 3.17 (95% CI, 1.12–8.97; p=0.030), respectively. On subgroup analysis there was no difference observed in the CHF incidence for RCC vs. non-RCC patients. No evidence of publication bias was observed. Conclusions: This is the first comprehensive report to demonstrate that sunitinib use is associated with an increased risk of significant heart failure in cancer patients. [Table: see text]

scholarly journals FGFR4 Gly388Arg Polymorphism Reveals a Poor Prognosis, Especially in Asian Cancer Patients: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Jung Han Kim ◽  
Soo Young Jeong ◽  
Hyun Joo Jang ◽  
Sung Taek Park ◽  
Hyeong Su Kim
Keyword(s):  
Cancer Patients ◽  
Transmembrane Domain ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Disease Stage ◽  
Prognostic Impact ◽  
Free Survival ◽  
Patients With Cancer ◽  
Ovid Medline ◽  
Hazard Ratios

The fibroblast growth factor-4 receptor (FGFR4) is a member of receptor tyrosine kinase. The FGFR4 Gly388Arg polymorphism in the transmembrane domain of the receptor has been shown to increase genetic susceptibility to cancers. However, its prognostic impact in cancer patients still remains controversial. Herein, we performed this meta-analysis to evaluate the clinicopathological and prognostic impacts of the FGFR4 Gly388Arg polymorphism in patients with cancer. We carried out a computerized extensive search using PubMed, Medline, and Ovid Medline databases up to July 2021. From 44 studies, 11,574 patients were included in the current meta-analysis. Regardless of the genetic models, there was no significant correlation of the FGFR4 Gly388Arg polymorphism with disease stage 3/4. In the homozygous model (Arg/Arg vs. Gly/Gly), the Arg/Arg genotype tended to show higher rate of lymph node metastasis compared with the Gly/Gly genotype (odds ratio = 1.21, 95% confidence interval (CI): 0.99-1.49, p = 0.06). Compared to patients with the Arg/Gly or Arg/Arg genotype, those with the Gly/Gly genotype had significantly better overall survival (hazard ratios (HR) = 1.19, 95% CI: 1.05-1.35, p = 0.006) and disease-free survival (HR = 1.25, 95% CI: 1.03-1.53, p = 0.02). In conclusion, this meta-analysis showed that the FGFR4 Gly388Arg polymorphism was significantly associated with worse prognosis in cancer patients. Our results suggest that this polymorphism may be a valuable genetic marker to identify patients at higher risk of recurrence or mortality.

scholarly journals Baseline and Outcome Characteristics of Multiple Valve Surgery Compared with Single Valve Procedures in Mainland China: A Multicenter Experience

2019 ◽  
Vol 22 (6) ◽  
pp. E486-E493
Author(s):  
Lei Jin ◽  
Guan-xin Zhang ◽  
Lin Han ◽  
Chong Wang
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Congestive Heart Failure ◽  
Mainland China ◽  
Valve Surgery ◽  
Chronic Obstructive ◽  
Class Iii ◽  
Obstructive Pulmonary Disease ◽  
Baseline Characteristics

Background: To compare baseline and outcome characteristics of multiple valve surgery with single-valve procedures in a multicenter patient population of mainland China. Methods: From January 2008 to December 2012, data from 14,322 consecutive patients older than 16 years who underwent heart valve surgery at five cardiac surgical centers (except pulmonary valve operations) were collected. The patients were divided into seven subgroups according to the type of valve procedures, and baseline characteristics and postoperative outcomes were contrasted between all seven combinations of single-valve and multiple-valve procedures involving aortic, mitral, and tricuspid valves. Two independent logistic regression analyses were performed and multivariable risk factors for mortality were compared, with emphasis on single-valve versus multiple-valve surgery. Results: Baseline characteristics for MUV procedures (n = 8945) shared many differences to those for single-valve procedures (n = 5377). Proportion of females, chronic obstructive pulmonary disease, cerebrovascular disease, renal impairment, congestive heart failure, NHYA class III-IV, atrial fibrillation, pulmonary hypertension, and decreased ejection fraction were more common in MUV subgroups, and smoker, hypertension, dyslipidemia, active infectious endocarditis, and coronary bypass graft was less frequent. In-hospital mortality was higher for MUV as compared with single-valve procedures (2.4% versus 1.6%, P = .007). Preoperative independent predictors for mortality of patients undergoing MUV procedures were age, chronic obstructive pulmonary disease, diabetes mellitus, renal dysfunction, dialysis, congestive heart failure, cardiogenic shock, NYHA class III-IV, mitral stenosis, tricuspid regurgitation, mitral valve replacement, and concomitant CABG. However, risk factors for mortality were relatively different between single-valve and MUV procedures. Conclusion: Baseline characteristics and epidemiology were different between MUV and single-valve procedures. The in-hospital mortality and postoperative complications for MUV procedures remained considerably higher and determinants of mortality were relatively different across procedures types. These findings serve as a benchmark for further studies, as well as suggest a continued search for explanations of MUV outcomes.

scholarly journals Heart Failure and Cancer: Mechanisms of Old and New Cardiotoxic Drugs in Cancer Patients

2019 ◽  
Vol 5 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Alessandra Cuomo ◽  
Alessio Rodolico ◽  
Amalia Galdieri ◽  
Michele Russo ◽  
Giacomo Campi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cancer Patients ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Cardiovascular Toxicity ◽  
Biological Drugs ◽  
Patients With Cancer ◽  
Recent Advances ◽  
Clinical Presentations

Although there have been many improvements in prognosis for patients with cancer, anticancer therapies are burdened by the risk of cardiovascular toxicity. Heart failure is one of the most dramatic clinical expressions of cardiotoxicity, and it may occur acutely or appear years after treatment. This article reviews the main mechanisms and clinical presentations of left ventricular dysfunction induced by some old and new cardiotoxic drugs in cancer patients, referring to the most recent advances in the field. The authors describe the mechanisms of cardiotoxicity induced by anthracyclines, which can lead to cardiovascular problems in up to 48% of patients who take them. The authors also describe mechanisms of cardiotoxicity induced by biological drugs that produce left ventricular dysfunction through secondary mechanisms. They outline the recent advances in immunotherapies, which have revolutionised anticancer therapies.

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