Impact of valvular surgery according to frailty risk in patients with infective endocarditis.

BACKGROUND: Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population. METHODS: We performed a retrospective study using the 2016-2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups. RESULTS: A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34-68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation. CONCLUSIONS: Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.

Echocardiographic Criteria to Differentiate Constrictive Pericarditis From Restrictive Cardiomyopathy: A Meta-analysis.

Background: To assess the diagnostic accuracy of the Mayo Clinic echocardiographic criteria for differentiating between constrictive pericarditis and restrictive cardiomyopathy. Methods: We searched electronic databases for the date range from their inception to July 1, 2022. The index tests were the Mayo Clinic echocardiographic criteria. We performed a bivariate random-effects model to estimate the pooled sensitivity and specificity, each with 95% confidence interval (CI). The area under the curve of the summary receiver operator characteristic curves, with 95% CI, was also calculated. Results: We included 17 case-control studies involving 889 patients. The pooled sensitivity and specificity (95% CI), respectively, were as follows: ventricular septal shift, 82% (60%-94%) and 78% (65%-87%); respiratory variation in mitral inflow ≥ 14.6%, 71% (51%-85%) and 82% (66%-91%); septal e' velocity ≥ 8 cm/s, 83% (80%-87%) and 90% (83%-95%); septal e' velocity/lateral e' velocity ≥ 0.88, 74% (64%-82%) and 81% (70%-88%); and hepatic vein ratio in expiration ≥ 0.79, 73% (65%-81%) and 71% (19%-96%). The area under the curve of the summary receiver operator characteristic curves varied from 0.75 to 0.85, with overlapping CIs across index tests. Conclusions: Our meta-analysis suggests that all echocardiographic parameters from the Mayo Clinic criteria have good diagnostic accuracy for differentiating between constrictive pericarditis and restrictive cardiomyopathy.

Contexte: Évaluation de l'exactitude diagnostique des critères échocardiographiques de la clinique Mayo visant à faire la distinction entre une péricardite constrictive et une cardiomyopathie restrictive. Méthodologie: Nous avons effectué une recherche dans des bases de données électroniques pour la période s'étendant de leur date de création au 1er juillet 2022. Les tests de concordance portaient sur les critères échocardiographiques de la clinique Mayo. Nous avons réalisé un modèle à effets aléatoires et à deux variables afin d'estimer la sensibilité et la spécificité en fonction des données regroupées, chacune avec un intervalle de confiance (IC) à 95 %. L'aire sous la courbe des courbes caractéristiques sommaires de la performance du test, avec un IC à 95 %, a également été calculée. Résultats: Nous avons inclus 17 études cas-témoins comptant 889 patients. Selon les données groupées, la sensibilité et la spécificité (IC à 95 %), respectivement, étaient les suivantes : déplacement du septum interventriculaire, 82 % (60 à 94 %) et 78 % (65 à 87 %); variation respiratoire lors du remplissage mitral ≥ 14,6 %, 71 % (51 à 85 %) et 82 % (66 à 91 %); vitesse eʹ mesurée en septal ≥ 8 cm/s, 83 % (80 à 87 %) et 90 % (83 à 95 %); rapport vitesse eʹ mesurée en septal/vitesse eʹ mesurée en latéral ≥ 0,88, 74 % (64 à 82 %) et 81 % (70 à 88 %); et rapport veineux hépatique lors de l'expiration ≥ 0,79, 73 % (65 à 81 %) et 71 % (19 à 96 %). L'aire sous la courbe des courbes caractéristiques sommaires de la performance du test variait de 0,75 à 0,85, avec des IC se chevauchant dans les tests de concordance. Conclusions: Notre méta-analyse laisse entendre que tous les paramètres échocardiographiques de la clinique Mayo ont une bonne exactitude diagnostique pour faire la distinction entre la péricardite constrictive et la cardiomyopathie restrictive.

The added value of hypertonic saline solution to furosemide monotherapy in patients with acute decompensated heart failure: A meta-analysis and trial sequential analysis.

We assessed the effects of hypertonic saline solution (HSS) plus furosemide versus furosemide alone in patients with acute decompensated heart failure (ADHF). We searched four electronic databases for randomized controlled trials (RCTs) until June 30, 2022. The quality of evidence (QoE) was assessed using the GRADE approach. All meta-analyses were performed using a random-effects model. A trial sequential analysis (TSA) was also conducted for intermediate and biomarker outcomes. Ten RCTs involving 3013 patients were included. HSS plus furosemide significantly reduced the length of hospital stay (mean difference [MD]: -3.60 days; 95% confidence interval [CI]: -4.56 to -2.64; QoE: moderate), weight (MD: -2.34 kg; 95% CI: -3.15 to -1.53; QoE: moderate), serum creatinine (MD: -0.41 mg/dL; 95% CI: -0.49 to -0.33; QoE: low), and type-B natriuretic peptide (MD: -124.26 pg/mL; 95% CI: -207.97 to -40.54; QoE: low) compared to furosemide alone. HSS plus furosemide significantly increased urine output (MD: 528.57 mL/24 h; 95% CI: 431.90 to 625.23; QoE: moderate), serum Na+ (MD: 6.80 mmol/L; 95% CI: 4.92 to 8.69; QoE: low), and urine Na+ (MD: 54.85 mmol/24 h; 95% CI: 46.31 to 63.38; QoE: moderate) compared to furosemide alone. TSA confirmed the benefit of HSS plus furosemide. Due to the heterogeneity in mortality and heart failure readmission, meta-analysis was not performed. Our study shows that HSS plus furosemide, compared to furosemide alone, improved surrogated outcomes in ADHF patients with low or intermediate QoE. Adequately powered RCTs are still needed to assess the benefit on heart failure readmission and mortality.

Association Between Previous or Active Cancer and Clinical Outcomes in TAVR Patients: A Systematic Review and Meta-Analysis of 255,840 Patients.

Background: It has been proposed that transcatheter aortic valve replacement (TAVR) may be an option for patients with cancer and severe aortic stenosis. We assessed the association between previous or active cancer and clinical outcomes in TAVR patients. Methods: We searched four electronic databases from inception to March 05, 2021. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, myocardial infarction, stroke, acute kidney injury, pacemaker implantation, major bleeding, and vascular complications. All meta-analyses were performed using a random-effects model. Relative risks (RRs) and adjusted hazard ratios (aHRs) with their 95% confidence interval (95% CI) were pooled. Results: Thirteen cohort studies involving 255,840 patients were included. The time period for mortality ranged from inpatient to 10 years. Patients with active cancer had a higher risk of all-cause mortality using both crude (RR, 1.46; 95% CI, 1.13-1.88) and adjusted (aHR, 1.79; 95% CI, 1.43-2.25) estimates compared to non-cancer group. In contrast, the risk of cardiovascular mortality (RR, 1.26; 95% CI, 0.58-2.73), myocardial infarction (RR, 0.94; 95% CI, 0.34-2.57), stroke (RR, 0.90; 95% CI, 0.75-1.09), pacemaker implantation (RR, 0.87; 95% CI, 0.50-1.53), acute kidney injury (RR, 0.88; 95% CI, 0.74-1.04), major bleeding (RR, 1.15; 95% CI, 0.80-1.66), and vascular complications (RR, 0.96; 95% CI, 0.79-1.18) was similar between patients with or without cancer. Conclusion: Our review shows that TAVR patients with active cancer had an increased risk of all-cause mortality. No significant association with secondary outcomes was found.