Myocarditis prognosis varies substantially, hence identification of novel prognostic factors is crucial. The prognostic role of ultra-short heart-rate variability (HRV) in myocarditis remains unknown. In a retrospective study, adult patients admitted to a tertiary hospital due to clinically suspected myocarditis were included. Clinical, laboratory and HRV parameters were assessed as predictors of severe short term complications (heart failure (HF), dilated cardiomyopathy—DCM, ventricular arrhythmia—VA and death), utilizing logistic regression (LR). Accuracy was evaluated with receiver operating characteristic (ROC) curve area under the curve (AUC). HRV indices included standard deviation of normal beat intervals (SDNN) and root mean square of successive differences (RMSSD). 115 patients, aged 34 (±13) years old, were examined. Six patients (5%) developed severe HFrEF. RMSSD was included in a multivariate LR model (RMSSD < 10.72 ms adjusted odds ratio (AOR) 14.056, p-value 0.024). Model classification accuracy was very good, with an AUC of 86%. Eight patients (7%) developed DCM. RMSSD < 10.72 ms was included in a multivariate classification model (AOR 8.826, p-value 0.013); model classification AUC of 82%. HRV did not predict development of VA or death. SDNN and especially RMSSD may be prognostic indicators in myocarditis.

Background: Infective endocarditis (IE) is a disease that poses a serious health risk. It is important to identify high-risk patients early in the course of their treatment. In the current study, we evaluated the prognostic value of ultra-short heart-rate variability (HRV), an index of vagal nerve activity, in IE. Methods: Retrospective analysis was performed on adult patients admitted to a tertiary hospital due to IE. A logistic regression (LR) was used to determine whether clinical, laboratory, and HRV parameters were predictive of specific clinical features (valve type, staphylococcal infection) or severe short-term complications (cardiac, metastatic infection, and death). The accuracy of the model was evaluated through the measurement of the area under the curve (AUC) of the receiver operating characteristic curve (ROC). An analysis of survival was conducted using Cox regression. A number of HRV indices were calculated, including the standard deviation of normal heart-beat intervals (SDNN) and the root mean square of successive differences (RMSSD). Results: 75 patients, aged 60.3(±18.6) years old, were examined. When compared with published age- and gender-adjusted HRV norms, SDNN and RMSSD were found to be relatively low in our cohort (75%-76% lower than the median; 33%-41% lower than the 2^nd percentile). 26(34.6%) patients developed a metastatic infection, with RMSSD<7.03ms (adjusted odds ratio (aOR) 9.340, p = 0.002), incorporated in a multivariate LR model (AUC 0.833). Furthermore, 27(36.0%) patients were diagnosed with Staphylococcus IE, with SDNN<4.92ms (aOR 5.235, p = 0.004), a major component of the multivariate LR model (AUC 0.741). Multivariate Cox regression survival model, included RMSSD (HR 1.008, p = 0.012). Conclusion: SDNN, and particularly RMSSD, derived from ultra-short ECG recordings, may provide prognostic information about patients presenting with IE.

Actinomyces Odontolyticus is a gram-positive bacillus, usually found in the oropharynx, gastrointestinal and urogenital tracts, as commensal flora. Infections caused by this organism are rare but may occur, more commonly in immunocompromised patients. We report a case of a 54-year-old man, who presented to the emergency department (ED), with fever and chills. The patient had undergone an implantable cardioverter defibrillator (ICD) insertion, 5 months prior to his arrival, and was diagnosed with Actinomyces Odontolyticus bacteremia, during the hospitalization. Transesophageal echocardiogram (TEE) revealed vegetations on the tricuspid valve and the ICD electrode. This is the first reported case of ICD related Actinomyces endocarditis and bacteremia based on our literature review. This case emphasizes the importance of probing for the source of actinomyces infection, while considering the indolent properties of the disease. (C) 2021 The Authors. Published by Elsevier Ltd.

Background: Myocardial infarction (MI) is a common emergency with high rates of morbidity and mortality. Current risk stratification scores for non-ST-elevation MI (NSTEMI) use subjective or delayed information. Heart rate variability was shown to correlate with prognosis following MI. This study aimed to evaluate ultra-short heart rate variability (usHRV) as a prognostic factor in NSTEMI patients. Methods: A retrospective analysis was performed on 183 NSTEMI patients admitted to Rambam Health Care Campus in 2014. usHRV measures, including the standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD), were calculated. Logistic regression assessed whether clinical, laboratory, or usHRV parameters predicted severe in-hospital complications like heart failure (HF), atrial flutter/fibrillation (AFL/AF), ventricular tachycardia/fibrillation (VT/VF), and atrioventricular block (AVB). Both Cox and logistic regression were used for survival analysis. Results: Of 183 patients (71.6% male, mean age 67.1), 35 (19%) died within 2 years. In-hospital complications included 39 cases (21.3%) of HF, 3 cases (1.6%) of VT/VF, and 9 cases (4.9%) of AVB. Lower usHRV was significantly associated with higher mortality at 2 years and showed marginal significance at 90 days and 1 year. Increased usHRV was linked to a higher risk of in-hospital ventricular arrhythmia (VT/VF). Conclusions: Overall, this study is in agreement with previous research, showing a correlation between low usHRV and a higher mortality risk. However, the association between usHRV and the risk of VT/VF demands further investigation. More expansive prospective studies are needed to strengthen the observed associations.