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.

Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis S pontaneous coronary artery dissection (SCAD), a rare cause of myocardial infarction (MI) and sudden cardiac death, can present with various acute coronary symptoms. It usually occurs in the peripartum period. In association with strenuous exercise and heavy lifting, SCAD is rather sparsely documented in the medical literature. We report the case of a patient in whom heavy lifting caused SCAD, and we review the literature on this topic. Case ReportIn January 2014, a 54-year-old woman had acute-onset retrosternal chest pain immediately after gardening and disposing of a heavy basket of cut grass. She had a normal body weight, no relevant medical history, and no known risk factors for coronary artery disease. She was 4 years postmenopausal. After an hour of worsening pain, she presented at the emergency department, having experienced cardiac arrest and resuscitation en route. After she was intubated, an electrocardiogram (ECG) showed ST-segment elevation in leads V 2 through V 5 , so she underwent thrombolysis. The patient's troponin T level was elevated at 0.4 ng/mL. The next day, her ECG results were consistent with anterior MI. Coronary angiograms revealed a spiral dissection of the left anterior descending coronary artery (LAD) (Fig. 1), which was successfully treated by means of angioplasty and the implantation of 3 drug-eluting stents. The rest of the coronary tree was smooth. The patient was discharged from the hospital after an uneventful 6-day stay, with instructions to take aspirin, prasugrel, a β-blocker, and a statin. Seven months later, results of an exercise ECG were normal, and the patient had returned to normal activity and full-time work. DiscussionCoronary artery dissection refers to the splitting of the arterial wall layers, the result of which is a false lumen. This dissection can occur spontaneously; after chest trauma, percutaneous coronary intervention, or cardiac surgery; or as part of aortic dissection. Accumulated blood in the false lumen can encroach on the true lumen, thereby impairing blood flow and causing myocardial ischemia, MI, or sudden cardiac death. [1][2][3][4][5] Since the first description of SCAD, 6 approximately 320 documented cases have been reported. This figure might be misleading, because many of the reports were Case Reports

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