Temporal trends of infective endocarditis in North America from 2000 to 2017 – a systematic review

Objectives To examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Patients and Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews™, Ovid Embase™, Ovid Medline™, Scopus™, and Web of Science™ were searched for studies published between January 1, 2000 and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8,588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for two studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7-14.4%, while the percentage of patients who underwent surgery ranged from 6.4-16.0%. Conclusion Overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations have been highlighted for use in subsequent systematic reviews of IE

Renal function and cardiac structure and function following MI: the VALIANT echo study

Introduction: It is unknown if adverse cardiovascular outcomes in post-MI pts with reduced renal function can be attributed to abnormalities of cardiac structure or function. Methods: Quantitative echocardiographic (echo) analyses were performed at baseline in 603 pts with LV dysfunction, HF, or both after MI, from VALIANT. Estimated glomerular filtration rate (eGFR) was calculated using the MDRD equation, and divided into 4 groups (<45.0, 45.0–59.9, 60.0–74.9, ≥75.0). Echo characteristics were related to baseline eGFR. Results: Reduced eGFR was associated with increased death or HF hospitalization, and smaller LV end-diastolic volumes, higher wall motion score, larger LA volumes, and more MR. Neither EF, infarct segment length, RV function, nor mitral deceleration time varied by renal function. After adjusting for age, wall motion index, LA volume, and MR remained significantly associated with reduced eGFR. Conclusions: Pts with renal impairment have similar global RV and LV systolic function, infarct segment length, smaller ventricular volumes, and larger atrial volumes after MI. Reduced systolic function alone cannot account for worse outcomes in post-MI pts with renal impairment

Comparison of renal function and cardiovascular risk following acute myocardial infarction in patients with and without diabetes mellitus

Renal dysfunction is an independent risk factor for cardiovascular (cv) disease and its associated complications. diabetes mellitus (dm) is a common cause,of renal dysfunction. whether the presence or absence of din modifies the relation between renal dysfunction and cv disease is unclear. the valiant trial identified 14,527 patients with acute myocardial infarction complicated by either clinical or radiologic signs of heart failure and/or left ventricular dysfunction for whom baseline creatinine was measured. patients were randomly assigned to receive captopril, valsartan, or both. glomerular filtration rate (gfr) was estimated using the 4-component modification of diet in renal disease equation. using multivariable cox proportional modeling, the relation of overall mortality and composite cardiovascular events with estimated gfr (egfr) between patients with and without din was compared. mean egfrs were 66.8 +/- 22.0 and 71.2 +/- 21.0 ml/min/1.73 m(2) for patients with (n = 3,358) and without din (n = 11,169), respectively. the likelihood of experiencing death or the composite end point was higher in patients with than without dm for each level of renal function. the augmentation in risk of cv events based on reduced renal function was similar between groups. each decrease in egfr by 10 units was associated with hazards of 1.09 (95% confidence interval 1.06 to 1.12, p < 0.001) in patients with din and 1, 08 (95% confidence interval 1.06 to 1.10, p < 0.001) in patients without dm for risk of fatal and nonfatal cv outcomes independent of treatment assignment. in conclusion, although dm is associated with higher risk of renal dysfunction and adverse cv outcomes, patients without dm had a relation between renal function and cv risk similar to that for patients with dm after high-risk acute myocardial infarction

Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO study)

Severe right ventricular dysfunction independent of left ventricular ejection fraction increased the risk of heart failure (HF) and death after myocardial infarction (MI). The association between right ventricular function and other clinical outcomes after MI was less clear. Two-dimensional echocardiograms were obtained in 605 patients with left ventricular dysfunction and/or clinical/radiologic evidence of HF from the VALIANT echocardiographic substudy (mean 5.0 +/- 2.5 days after MI). Clinical outcomes included all-cause mortality, cardiovascular (CV) death, sudden death, HF, and stroke. Baseline right ventricular function was measured in 522 patients using right ventricular fractional area change (RVFAC) and was related to clinical outcomes. Mean RVFAC was 41.9 +/- 4.3% (range 19.2% to 53.1%). The incidence of clinical events increased with decreasing RVFAC. After adjusting for 11 covariates, including age, ejection fraction, and Killip's classification, decreased RVFAC was independently associated with increased risk of all-cause mortality (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.31 to 1.98), CV death (HR 1.62, 95% CI 1.30 to 2.01), sudden death (HR 1.79, 95% CI 1.26 to 2.54), HF (HR 1.48, 95% CI 1.17 to 1.86), and stroke (HR 2.95, 95% CI 1.76 to 4.95), but not recurrent MI. Each 5% decrease in baseline RVFAC was associated with a 1.53 (95% CI 1.24 to 1.88) increased risk of fatal and nonfatal CV outcomes. In conclusion, decreased right ventricular systolic function is a major risk factor for death, sudden death, HF, and stroke after MI