European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

New diagnostic criteria for infective endocarditis. A study of sensitivity and specificity.

OBJECTIVE: The purpose of this study was to determine the sensitivity and specificity of new criteria proposed by Duke University for case definition of infective endocarditis as compared to the previously accepted Von Reyn criteria. PATIENTS: A total of 143 consecutive suspected cases of infective endocarditis in 137 febrile patients were included. Of these, 69 had infective endocarditis, pathologically proven in 28, but with only a clinical diagnosis in 41. In the remaining 74 cases, the diagnosis of infective endocarditis was rejected after a follow-up of at least 3 months. RESULTS: The sensitivity of Duke's criteria was significantly higher, both when patients with possible infective endocarditis were considered as true-positive (definition 1; 100% vs 69%, P < 0.001) and when possible cases were considered as rejected (definition 2; 76% vs 51%, P < 0.01). Specificity was very high with both criteria: 92% Von Reyn vs 88% Duke (ns) with definition 1 and 99% Von Reyn vs 97% Duke (ns) with definition 2. The overall accuracy of the Duke criteria in the entire population was significantly higher with both definitions (0.94 vs 0.81 definition 1, P < 0.001; 0.87 vs 0.75, P = 0.015 definition 2). CONCLUSION: Duke's criteria for defining infective endocarditis has been shown to be more sensitive than previously adopted criteria, while maintaining a high degree of specificity. Therefore, they must be accepted as a substitute for previous criteria.

Diagnostic value of echocardiography in infective endocarditis: a probabilistic approach.

The high sensitivity and specificity of echocardiography in the diagnosis of infective endocarditis have been well established for a number of years. However, little is known yet about the incremental value of this technique over the clinical and serological findings already available in subsets of patients presenting different initial probabilities in infective endocarditis. In this report, sensitivity and specificity of echocardiography were calculated in 173 consecutive patients with suspected infective endocarditis who underwent echocardiography within 5 days following admission. The echocardiogram was considered positive when Duke major criteria were fulfilled. Infective endocarditis was diagnosed in 88 patients, while other illnesses in the remaining 85. The diagnoses were confirmed retrospectively with a follow-up done after at least 3 months, at surgery or during autopsy. Sensitivity and specificity of the echocardiography in this population were 85 and 97% respectively. The initial probabilities of infective endocarditis in patients with different clinical presentations were taken from a thorough review of the literature available in English and from personal research. The positive predictive value of echocardiography is already high or very high even at low or very low levels of initial probability, and this has a strong impact on clinical decisions. In these situations and with intermediate probabilities, a negative echocardiogram would theoretically rule out the disease. However, this result, if considered alone, calls for a careful reassessment of the entire clinical context. As with any other test, when the initial probabilities of infective endocarditis are highest, the incremental value of echocardiography is poor.

[Cardiac complications in HIV infections]. / Complicazioni cardiache nella infezione HIV.

UNLABELLED: Cardiological involvement in HIV infection is relatively rare but it presents important clinical aspects that are still open questions. We report our experience with HIV patients who underwent cardiological evaluation, Doppler echocardiography and follow-up. MATERIAL AND METHOD: We selected 127 patients (9%) on the basis of clinical suspicion of heart disease, taking them from the 1398 admitted for HIV infection between 1992 and 1995. Ninety-six patients had AIDS (group A) and 31 were in pre-AIDS phase (group B). The age was 21-52 years: 83 were males, 44 were females and 91% of the patients had been drug addicts. Echocardiography was executed with Hp Sonos 1000 and Sonos 2500 devices. Follow-up was 6-36 months. RESULTS: Ninety-two patients (6.5% on total admitted patients) had heart disease. Thirty-five patients were normal on echocardiography. Other diseases were: pericardial effusion in 38 cases (30%), with CD4+ number significantly lower (p < 0.005); dilated cardiomyopathy in 20 patients (16%), with a low CD4+ number (p < 0.005); reversible segmental or diffuse hypokinesia compatible with clinical myocarditis was seen in 11 patients (9%), especially in group A (p < 0.005); infective endocarditis in 17 patients (13%), especially group B (p < 0.005); right ventricular dilatation in 7; discrete right ventricular mass in 3 patients. Sixty-five patients (51%) died during follow-up (group A only). There were 19 cardiac deaths (15%), which represents 1.3% of the total number of patients. Nine of these (47%) were in patients with cardiomyopathy. Total mortality was 85% in patients with dilated cardiomyopathy, 73% in myocarditis cases, 71% in pericarditis cases (especially extracardiac), 66% in right ventricular dilatation cases, 18% in endocarditis cases, 34% in normal cases. CONCLUSIONS: Cardiac complications assume clinical importance, especially in the AIDS phase of HIV infection, but early diagnosis in the pre-AIDS phase is important for treatment. Clinical evaluation and echocardiography are corner-stones of the diagnosis. Prognosis depends especially on the clinical stage of HIV infection and myocardial involvement.