Introduction: Despite growing evidence for sex-specific differences in cardiovascular disease, sex is poorly considered in the management of infectious endocarditis (IE).Purpose: This study aimed to assess sex-specific aspects in diagnosing IE.Methods: All consecutive patients admitted at Ulm University Heart Center with suspected IE between 2009 and 2019 were included. IE was diagnosed using the Duke criteria. Risk factors, clinical presentation and in-hospital outcomes along with the impact of diagnostic delay were compared between male and female patients.Results: IE was diagnosed in 96 of 118 men (81.4%) and 33 of 45 women (73.3%) (p = 0.121). Time to diagnosis was similar between the groups (p = 0.598). Regarding patient characteristics, men were younger (65.5 vs. 74.3 years, p = 0.006). Men exhibited a higher prevalence of predisposing cardiac conditions (p = 0.012) due to a higher frequency of a history of implantable cardioverter defibrillator implantation (p = 0.004), and were more likely to have poor dental status (p = 0.001), and coronary artery disease (p = 0.002). The incidence of the complications of heart failure with reduced ejection fraction (p = 0.007) and new-onset dialysis (p = 0.012) were higher, the time in the intensive care unit (p = 0.012) longer. Male sex was the only independent risk factor for in-hospital mortality [p = 0.036, HR 4.127 (95%-CI 1.096-15.538)]. Notably, only in the male cohort, a shorter time to diagnosis was associated with a lower mortality rate (p = 0.035, optimal cut-point 3.5 days). Men diagnosed within 3.5 days had a mortality rate of 13.5% compared to 31.8% for those diagnosed later (p = 0.028).Conclusion: Men with suspected IE are younger, have more predisposing factors and experience a more complicated course of disease, while benefiting from early diagnosis. Therefore, recognizing the heightened risk profile specific to men during diagnosis can help to address their poorer prognosis.

Background: Data on the relation between non-emergency and emergency cardiac admission rates during the COVID-19 lockdown and post-lockdown period are sparse. Methods: Consecutive cardiac patients admitted to our tertiary heart center between 1 January and 30 June 2020 were included. The observation period of 6 months was analyzed in total and divided into three defined time periods: the pre-lockdown (1 January–19 March), lockdown (20 March–19 April), and post-lockdown (20 April–30 June) period. These were compared to the reference periods 2019 and 2022 using daily admission rates and incidence rate ratios (IRR). Results: Over the observation period from 1 January to 30 June, cardiac admissions (including non-emergency and emergency) were comparable between 2019, 2020, and 2022 (n = 2889, n = 2952, n = 2956; p = 0.845). However, when compared to the reference period 2019, non-emergency admissions decreased in 2020 (1364 vs. 1663; p = 0.02), while emergency admissions significantly increased (1588 vs. 1226; p < 0.001). Further analysis of the lockdown period revealed that non-emergency admissions dropped by 82% (IRR 0.18; 95%-CI 0.14–0.24; p < 0.001) and 42% fewer invasive cardiac interventions were performed (p < 0.001), whereas the post-lockdown period showed a 52% increase of emergency admissions (IRR 1.47; 95%-CI 1.31–1.65; p < 0.001) compared to 2019. Conclusions: We demonstrate a drastic surge of emergency cardiac admissions post-COVID-19 related lockdown suggesting that patients who did not keep their non-emergency appointment had to be admitted as an emergency later on.

Background/Objectives: Timely diagnosis of infective endocarditis (IE) remains a significant challenge, and IE poses significant morbidity and mortality. Modified Duke criteria (MDC) are used for the clinical evaluation and diagnosis of IE, but their current use is dichotomous. There are no studies that associate the amount of positive MDC with the patient’s outcome. This study intends to analyze whether the amount of MDC on initial presentation can be used for prognostic assumptions. Methods: We conducted a retrospective data analysis on patients with confirmed and suspected IE who were treated at the Department of Internal Medicine II at Ulm University Heart Center from December 2009 to December 2019. Univariable and multivariable logistic regression models were used to find correlations between 90-day mortality and the number of MDC. Results: 130 patients with confirmed IE were included in the analysis. Less minor MDC (OR 1.718; 95%-CI 1.096–3.268; p = 0.022) and a history of coronary artery disease (OR 4.711; 95%-CI 1.791–12.393; p = 0.002) were independently associated with higher 90-day mortality in patients with ultimately confirmed IE. Fewer minor MDC on presentation were associated with later diagnosis (b 2.341; 95%-CI 0.312–4.370; p = 0.024) and antibiotic therapy (b 2.953; 95%-CI 0.82–5.084; p = 0.007) for IE. Conclusions: Early diagnosis of IE is essential for favorable outcomes. Fewer minor MDC on initial presentation may lead to delayed diagnosis, antibiosis, and worse outcomes.

Background/Objectives: It is unclear whether assessment of phasic atrial function could improve risk stratification for new-onset atrial fibrillation (AF) in patients with newly diagnosed cardiac sarcoidosis (CS). We aimed to investigate the prognostic value of left atrial (LA) phasic dysfunction by cardiac magnetic resonance (CMR) for new-onset AF in newly diagnosed patients with CS. Methods: 78 patients with CS, without a prior history of AF, were studied using CMR feature tracking. Over a 4-year follow-up period, AF was documented by Holter monitoring and interrogation of intracardiac devices. Clinically silent CS was defined as CS in patients with biopsy-proven extracardiac sarcoidosis, with no cardiac symptoms, but with abnormalities on CMR or positron emission tomography consistent with CS. Results: Patients with clinically manifest CS were younger (mean age 56 vs. 51 years, p = 0.018), had poorer ventricular function, higher extent of atrial late gadolinium enhancement and significantly lower LA reservoir, conduit and booster function compared to patients with clinically silent CS. Over a 4-year follow-up period, 39% of patients with clinically manifest CS and 29.7% of patients with clinically silent CS developed AF. LA reservoir strain was a strong predictor of AF in the entire cohort. In subgroup analysis, age (HR 1.30, 95% CI 1.02–1.65, p = 0.030) and LA reservoir strain (HR 0.63, 95% CI 0.44–0.90, p = 0.011) were independent predictors of AF in patients with clinically silent CS, whereas baseline NT-proBNP (HR 1.003, 95% CI 1.001–1.006, p = 0.017) predicted AF in patients with clinically manifest CS. Conclusions: Reduced LA reservoir strain on CMR predicts new-onset AF in patients with newly diagnosed CS. The predictive value of LA reservoir strain is strongest in clinically silent CS and decreases with disease progression in clinically manifest CS.