CT assessment of the left atrial appendage post-transcatheter occlusion - A systematic review and meta analysis.

BACKGROUND: Transesophageal echocardiography (TEE) is the standard imaging modality used to assess the left atrial appendage (LAA) after transcatheter device occlusion. Cardiac computed tomography angiography (CCTA) offers an alternative non-invasive modality in these patients. We aimed to conduct a comparison of the two modalities. METHODS: We performed a comprehensive systematic review of the current literature pertaining to CCTA to establish its usefulness during follow-up for patients undergoing LAA device closure. Studies that reported the prevalence of inadequate LAA closure on both CCTA and TEE were further evaluated in a meta-analysis. 19 studies were used in the systematic review, and six studies were used in the meta-analysis. RESULTS: The use of CCTA was associated with a higher likelihood of detecting LAA patency than the use of TEE (OR, 2.79, 95% CI 1.34-5.80, p â€‹= â€‹0.006, I2 â€‹= â€‹70.4%). There was no significant difference in the prevalence of peridevice gap ≥5 â€‹mm (OR, 3.04, 95% CI 0.70-13.17, p â€‹= â€‹0.13, I2 â€‹= â€‹0%) between the two modalities. Studies that reported LAA assessment in early and delayed phase techniques detected a 25%-50% higher prevalence of LAA patency on the delayed imaging. CONCLUSION: CCTA can be used as an alternative to TEE for LAA assessment post occlusion. Standardized CCTA acquisition and interpretation protocols should be developed for clinical practice.

Contemporary Trends in Native Valve Infective Endocarditis in United States (from the National Inpatient Sample Database).

Infective Endocarditis (IE) is associated with high mortality and morbidity. The data on contemporary trends and health care utilization remain scarce for IE. Consequently, we used the National Inpatient Sample database from 2002 to 2016 to study burden of IE. Risk-adjusted rates were calculated using an Analysis of Covariance with the Generalized Linear Model. Trends were assessed with linear regression and Pearson's Chi-square modeling, where appropriate. Binomial logistic regression was used for computing predictors of in-hospital mortality. We identified 523,432 hospitalizations for native valve IE. Risk-adjusted mortality decreased from 16.7% in 2002 to 9.7% in 2016 (p <0.01). The risk-adjusted length of stay decreased from 17.4 days in 2002 to 13.4 days in 2016 (p <0.01). Mean cost of stay adjusted for risk factors and inflation increased from 112,702$ in 2002 to 164,767$ in 2016 (p <0.01). Valve replacement increased from 10.2% in 2002 in to 13.4% in 2016, (p <0.01). Independent predictors of mortality included age (OR, 1.02 [1.02 to 1.020], p <0.01), female gender (OR, 1.07 [1.05 to 1.09], p <0.01), Blacks (OR, 1.28 [1.24 to 1.31], p <0.01), Hispanics (OR, 1.15 [1.11 to 1.19], p <0.01) and patients with co-morbid conditions like congestive heart failure (OR, 1.78 [1.74 to 1.82], p <0.01), renal failure (OR, [1.69 [1.65 to 1.73], p <0.01) and weight loss (OR, 1.40 [1.36 to 1.43], p <0.01). In summary, in-hospital mortality from native valve IE has been decreasing but total hospitalization and average cost of stay has increased.