Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Implications of serial measurements of natriuretic peptides in heart failure: insights from BIOSTAT‐CHF

No abstract available

G017 Factors associated with the induction of antidromic tachycardia in the wolff-parkinson-white syndrome

Atrioventricular reentrant tachycardia (AVRT) is the most frequent inducible tachycardia in patients with a Wolff-Parkinson-White syndrome (WPW). The incidence and the causes of the induction of antidromic tachycardia (ATD) are unknown. The purpose of the study was to determine the data of patients with a WPW and with inducible ATD.Methods605 patients had a WPW and tachycardias (n=312) or syncope (n=85); other patients were asymptomatic (n=208). Electrophysiological study (EPS) was systematic. In control state (CS), the higher rate conducted through accessory pathway (AP) was measured; programmed atrial stimulation with 1, 2 extrastimuli was performed to induce a tachycardia. Isoproterenol (0.02 to 1μg. min-1) was infused and the protocol was repeated.ResultsATD was induced in 44 patients (7 %) (group I). Their data were compared to those of remaining patients (group II). Group I differed from group II by the following data: Female sex was less frequent in group I (29.5 %) than in group II (47 %); AP was more frequently left sided in group I (54.5 %) than in group II (38 %) (p<0.05). AVRT was induced less frequently in group I (34 %) than in group II (57 %) (p<0.01); maximal rate conducted through AP was higher in group I (215±52b/min) than in group II (189±61) in control state, and after isoproterenol (281±57 in group I vs 236±61 in group II) (p<0.001). Some data were similar: Age was not different in group I (33.5±20 years) and II (34.5±17); the indications of EPS were similar (syncope, reentrant tachycardia, atrial fibrillation (AF) or asymptomatic WPW were the reasons for 16 %, 43 %, 11 % and 25 % of group I patients and 14 %, 46 %, 5.5 % and 35 % of group II patients); posteroseptal and right AP locations were similar in both groups; AF was induced as frequently in group I (27 %) as in group II (23 %).Conclusionsantidromic tachycardia was induced more frequently in men than in women, with a left lateral AP which conducted more rapidly than in other patients