Background: This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward. Methods: We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m²); G2 (eGFR 89–60 mL/min/1.73 m²); G3a (eGFR 59–45 mL/min/1.73 m²); G3b (eGFR 44–30 mL/min/1.73 m²); G4 (eGFR 29–15 mL/min/1.73 m²); G5 (eGFR <15 mL/min/1.73 m²). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed. Results: A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen’s kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05–17.80; G4 HR7.13; 95%CI 1.63–31.23; G5 HR25.91; 95%CI 6.63–101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations. Conclusion: In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations.

Pseudoaneurysm (PSA) of the left ventricle (LV) is a rare peri-annular complication of infective endocarditis (IE), and it is associated with high risk of free wall rupture. The diagnosis is challenging because the exact incidence and the pathogenesis are still unclear. A 69-year-old lady underwent prosthetic mitral valve replacement for IE secondary to Staphylococcus aureus sepsis complicated by multiple embolizations. In the post-operative period, the patient developed persistent low-grade fever with negative blood culture. Transoesophageal echocardiography (TOE) revealed complete posterior valve detachment and a PSA sac arising from the antero-lateral commissure; the colour flow Doppler showed massive mitral regurgitation. Thoracic computed tomography (CT) scan confirmed the echo data and the exact localization of the cardiac rupture. The patient underwent reoperation, a pericardial patch was sutured to exclude the PSA sac, and a mechanical prosthesis valve was finally implanted. A follow-up TOE revealed the exclusion of the PSA; two leakages with mild peri-valvular mitral regurgitation were found, with no haemodynamic impact. In our case, the patient developed a PSA of the LV as a consequence of peri-annular extension of IE on the mitral valve. Pseudoaneurysm is a potentially lethal complication, if not promptly treated. Multimodality imaging including echocardiography and CT scan is recommended, in order to plan surgery ad hoc.