Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive ). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.

Background Type 2 cardiorenal syndrome is a serious, life threatening clinical condition, associated with adverse clinical outcomes. Although several prognostic biomarkers have been reported, early and accurate prognosis still remains a challenge. Aims This study was aimed to identify the best prognostic renal markers, to develop and validate an individualized predictive formula for the mortality risk in type 2 cardiorenal patients. Methods A total of 170 hospitalized patients (between 2014 and 2018) were included in this study. Renal function and glomerular filtration rate (GFR) was assessed using the most popular formulas for GFR estimation: the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD), CKD-Epidemiology Collaboration (CKD-EPI) based on serum cystatin-C, creatinine and their combination, and the simple cystatin-C formula. All data were used to screen the predictors via univariate and multivariate analyses. A model was developed based on these predictors and validated by internal validation. The model validation comprised discriminative ability determined by the area under the curve (AUC) of receiver operating characteristic (ROC) curve and the predictive accuracy by calibration plots. Results During a mean follow-up of 6 months, 29 (16.2%) deaths were recorded. In an adjusted model, renal biomarkers and estimated glomerular filtration rate showed different prognostic value according to the area under the curve. Area under the ROC curve was 0.58 (95% CI:0.47–0.69, P=0.05) for serum creatinine, 0.67 (95% CI: 0.56–0.79, P&lt;0.05) for serum cystatin-C; 0.76±0.05 (95% CI: 0.67–0.82, P&lt;0.01) for CKD-EPI formula based on serum cystatin-C; 0.73±0.06 (95% CI: 0.65–0.79, P&lt;0.01) for simple formula based on serum cystatin-C; 0.72±0.05 (95% CI: 0.64–0.79, P&lt;0.01) for CKD-EPI formula based on serum cystatin-C and serum creatinine; 0.617±0.06 (95% CI: 0.53–0.69, P&lt;0.01) for CKD-EPI formula based on serum creatinine; 0.615±0.06 (95% CI: 0.53–0.69, P&lt;0.01) for sMDRD formula and 0.58±0.07 (95% CI: 0.53–0.69, P&lt;0.01) for CG formula. Multivariate logistic regression revealed that cardiovascular disease length, psycho-emotional stress, NYHA class, hemoglobin, serum cystatin-C and GFR using the simple cystatin-C formula were independently associated with mortality in type 2 cardorenal syndrome. A model developed based on the seven variables had a specificity of 79.31%, and sensitivity 78.72% (P&lt;0.01), while AUC was 0.792 (P&lt;0.01), in internal validation. Conclusion GFR is an independent predictor for short term mortality of type 2 cardiorenal syndrome. Cystatin-C based formulas seems to offer improved prognostication in this population, while CG formula and serum creatinine fail to predict short term mortality The proposed model could predict the individualized mortality risk with good accuracy, high discrimination, and potential clinical applicability in cardiorenal patients. Funding Acknowledgement Type of funding source: None

Primary percutaneous coronary intervention (PPCI) is the gold standard of treating patients with acute coronary syndrome (ACS). The results of major clinical trials on ACS patients’ treatment are reflected in modern guidelines, where PPCI is of high evidence level and is superior to conservative therapy in long-term treatment results. Treatment of elderly patients over 75 years old is carried due to modern clinical guidelines, even though few patients of this age group are included in the studies. The increase in population average life expectancy causes the increase in number of elderly ACS patients with comorbid pathology. In its turn, it affects both the choice of treatment tactics and PPCI volume. Therefore, a study of this age group is required. The present review reflects the main clinical studies and analysis of elderly patients’ treatment

Affectation du système musculosquelettique chez les patients atteints d'endocardite infectieuse Introduction. L'endocardite infectieuse (EI) est un trouble cardiovasculaire grave portant sur les valves natives, l'endocarde ventriculaire ou auriculaire, des corps étrangers intracardiaques (valves prothétiques, pacemaker ou défibrillateur intracardiaque) et extracardiaques (système musculosquelettique, neurologique, néphrologique etc.) des complications avec une mortalité élevée et à mauvais pronostic. Les objectifs étaient d'évaluer les caractéristiques cliniques et de laboratoire de l'endocardite infectieuse associée aux manifestations musculosquelettiques. Méthodes. L'étude a été menée sur un échantillon de 235 patients, 185 étant hospitalisés dans les sections de cardiologie des départements spécialisés, y compris quatre centres médicaux, entre novembre 2014 et mars 2016. Tous les patients inclus à l'étude remplissant les critères diagnostiques de l'endocardite infectieuse développés selon Duke Endocarditis Service (Durham, Caroline du Nord), révisés en 1994 et 2007. Résultats. Selon la présence ou l'absence de manifestations musculosquelettiques (MMS), les patients ont été divisés en 2 groupes: 1er groupe-90 avec EI et MMS (38%) et 2ème groupe-145 patients recevant une avec EI sans MMS (72%). De cette façon, nous