The risk for embolism during infective endocarditis can be quantified at admission using a simple and accurate calculator. It might be useful for facilitating therapeutic decisions.
The 5-year survival free of events (death or need for aortic valve replacement) was 56 ± 3% for DI >0.25, 41 ± 6% for DI 0.20 to 0.25, and 22 ± 5% for DI <0.20 (p for trend <0.001). The risk of events increased linearly with DI <0.25 (adjusted hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.05 to 1.29) per 0.05 DI decrement; p = 0.015). On multivariable analysis, compared with patients with DI >0.25, those with DI 0.20 to 0.25 and those with DI <0.20 incurred an excess risk of events (adjusted HR: 1.65; 95% CI: 1.20 to 2.27 for DI 0.20 to 0.25 vs. DI >0.25, and adjusted HR: 2.62; 95% CI: 1.90 to 3.63 for DI <0.20 vs. DI >0.25). The association of DI and outcome was consistent in subgroups, with no interaction between DI outcome prediction and LVOT diameter, body surface area, or index stroke volume (all p for interaction ≥0.10) CONCLUSIONS: Our results demonstrate that the DI is a simple and reliable marker of AS severity with clear prognostic implications. DI <0.25 is associated with an excess risk of events after diagnosis; therefore, this cutoff should be used for AS severity assessment and for therapeutic decisions.
Incidence of POAF is high after AVR for severe aortic stenosis. Our results suggest an additive value of the study of left ventricular myocardial deformation to classical clinical and echocardiographic variables for the prediction of POAF in this setting.
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