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BACKGROUND Cardiac surgery for infective endocarditis (IE) is associated with significant hospital mortality, and female sex may be associated with worse outcomes. However, the impact of sex on the presenting characteristics, management, and outcomes of patients operated on for acute infective endocarditis (IE) has not been adequately studied. OBJECTIVES The goal of our study was to analyse differences in management and outcome of IE between women and men who undergo surgery. METHODS Clinical data of 717 patients undergoing cardiac surgery for IE between December 2005 and December 2019 were prospectively collected. Sex-related postoperative outcomes including in-hospital mortality were recorded. Univariable and multivariable analyses were performed to identify potential sex-related determinant of in-hospital mortality. RESULTS In all, 532 male patients (74.2%) and 185 female patients (25.8%) underwent surgery for IE. At baseline, women had more frequent mitral regurgitation with 63 patients (34.1%) than men with 135 patients (25.4%) (P  = 0.002). Female sex was associated with higher in-hospital mortality (23.2% versus 17.3%, P  = 0.049). However, multivariable analysis revealed age (P  < 0.01), antibiotics < 7 days before surgery (P  = 0.01) and staphylococcal IE (P  < 0.01) but not female sex (P  = 0.99) as independent determinants of hospital mortality. CONCLUSIONS In this study of patients operated-on for IE, female sex was associated with more severe manifestations of IE and significantly higher in-hospital mortality. However, after multivariable analysis, initial presentation, but not sex, seemed to determine clinical outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the relationship between aortic valve disease and heart failure with mildly reduced ejection fraction (HFmrEF). It highlights the importance of left ventricular ejection fraction (LVEF) as a prognostic factor and driver for intervention in valvular disease. The article also emphasizes the role of multimodality imaging in understanding LV remodeling and identifying other causes of LV dysfunction. The study by Schupp et al. provides insights into the risk stratification of HFmrEF patients with aortic valve disease, particularly aortic stenosis (AS). It suggests the need for improved knowledge of the interactions between valvular disease and LV function to optimize patient management. The article cautions against overinterpretation of the association between mild AS and poor outcomes, and highlights the underuse of interventions on the aortic valve in patients with severe AS and HFmrEF. It concludes by calling for further research to elucidate the underlying mechanisms of the association between valvular disease and impaired outcomes in HFmrEF patients. [Extracted from the article]

• Beta-blocker efficiency in reducing mortality after MI is well established. • This efficiency was demonstrated before the reperfusion therapy era. • Uncomplicated MI has a low risk of subsequent mortality and cardiovascular events. • It is easily identified by LVEF ≥ 40% and absence of recurrent events at 6 months. • Patients with uncomplicated MI seem ideal candidates for beta-blocker withdrawal. • This hypothesis was tested in the randomized AβYSS trial. Systematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction. To evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use. We included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the "uncomplicated myocardial infarction" group (n = 1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the "complicated myocardial infarction" group (n = 366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the "left ventricular dysfunction" group (n = 461), defined by a left ventricular ejection fraction < 40%. During a median follow-up of 2.7 years (interquartile range 1.0–4.9 years), the "uncomplicated myocardial infarction" group was at low mortality risk compared with the "complicated myocardial infarction" group (hazard ratio 0.38, 95% confidence interval 0.25–0.58; P < 0.01) and the "left ventricular dysfunction" group (hazard ratio 0.22, 95% confidence interval 0.15–0.32; P < 0.01). Beta-blockers were prescribed at discharge predominantly in the "uncomplicated myocardial infarction" group (93%) compared with 87% in the "complicated myocardial infarction" group and 81% in the "left ventricular dysfunction" group. Beta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers–largely prescribed in lower-risk patients–remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events. [ABSTRACT FROM AUTHOR]