1
|
Jain A, Subramani S, Gebhardt B, Hauser J, Bailey C, Ramakrishna H. Infective Endocarditis-Update for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2023; 37:637-649. [PMID: 36725476 DOI: 10.1053/j.jvca.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
Collapse
Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, MA
| | - Joshua Hauser
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Caryl Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
2
|
Contemporary Review of Multi-Modality Cardiac Imaging Evaluation of Infective Endocarditis. Life (Basel) 2023; 13:life13030639. [PMID: 36983795 PMCID: PMC10052933 DOI: 10.3390/life13030639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and 18F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.
Collapse
|
3
|
Cimmino G, Bottino R, Formisano T, Orlandi M, Molinari D, Sperlongano S, Castaldo P, D’Elia S, Carbone A, Palladino A, Forte L, Coppolino F, Torella M, Coppola N. Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management. Life (Basel) 2023; 13:life13020377. [PMID: 36836734 PMCID: PMC9965398 DOI: 10.3390/life13020377] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. If bacteremia develops, infected vegetation on the native/prosthetic valve or any intracardiac/intravascular device may occur as the final result of invading microorganisms/host immune system interaction. In the case of IE suspicion, all efforts must be focused on the diagnosis as IE can spread to almost any organ in the body. Unfortunately, the diagnosis of IE might be difficult and require a combination of clinical examination, microbiological assessment and echocardiographic evaluation. There is a need of novel microbiological and imaging techniques, especially in cases of blood culture-negative. In the last few years, the management of IE has changed. A multidisciplinary care team, including experts in infectious diseases, cardiology and cardiac surgery, namely, the Endocarditis Team, is highly recommended by the current guidelines.
Collapse
Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: or ; Tel.: +39-0815664141
| | - Roberta Bottino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Massimiliano Orlandi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Simona Sperlongano
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Pasquale Castaldo
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Saverio D’Elia
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Andreina Carbone
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Alberto Palladino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Lavinia Forte
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| |
Collapse
|
4
|
Jensen AD, Østergaard L, Petersen JK, Graversen PL, Butt JH, Hadji-Turdeghal K, Dahl A, Bruun NE, Iversen K, Bundgaard H, Køber L, Fosbøl EL. Temporal trends of mortality in patients with infective endocarditis: a nationwide study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:24-33. [PMID: 35259247 DOI: 10.1093/ehjqcco/qcac011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/22/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS Little is known about the mortality for patients with infective endocarditis (IE) on a nationwide scale, and previous studies have been conducted in selected cohorts from tertiary centers. We aimed to investigate temporal trends in mortality using nationwide Danish registries. METHODS AND RESULTS We identified patients with first-time IE between 1999-2018, and they were grouped by calendar periods (1999-2003, 2004-2008, 2009-2013, 2014-2018). One-year mortality was estimated using Kaplan-Meier estimates. For calendar periods, odds ratios (ORs) and hazard ratios (HRs) were computed using multivariable adjusted logistic regression and Cox proportional Hazards analyses for in-hospital and one-year mortality, respectively. We identified 8804 patients with IE. Age and proportions of men were: 66.7 (25th-75th percentile: 53.4-76.7) years and 59.9% in 1999-2003 and 72.8 (25th-75th percentile: 63.4-80.3) and 65.8% in 2014-2018. In-hospital mortality was 1999-2003: 24.5%, 2004-2008: 22.8%, 2009-2013: 18.8%, and 2014-2018: 18.3%. Relative to 1999-2003, adjusted likelihoods of in-hospital mortality were: OR = 0.81 (95% CI: 0.69-0.96) in 2004-2008, OR = 0.59 (95% CI: 0.50-0.69) in 2009-2013, and OR = 0.51 (95% CI: 0.43-0.60) in 2014-2018. By calendar periods, crude risks of one-year mortality were: 34.4% (95% CI: 32.0-36.8%), 33.5% (95% CI: 31.5-35.6%), 32.1% (95% CI: 30.2-34.0%), and 33.1% (95% CI: 31.3-34.8%). Relative to 1999-2003, adjusted rates of one-year mortality were: HR = 0.88 (95% CI 0.79-0.99) in 2004-2008, HR = 0.76 (95% CI: 0.68-0.86) in 2009-2013, and HR = 0.72 (95% CI: 0.64-0.81) in 2014-2018. CONCLUSION In this nationwide study of patients with first-time IE between 1999-2018, both short- and long-term survival has improved over time when accounting for changes in patient characteristics. ONE-SENTENCE SUMMARY When accounting for patient characteristics, both short- and long-term mortality have improved in patients with first-time infective endocarditis.
Collapse
Affiliation(s)
- Andreas Dalsgaard Jensen
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark
| | - Jeppe Kofoed Petersen
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark
| | - Peter Laursen Graversen
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark
| | - Jawad Haider Butt
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark
| | - Katra Hadji-Turdeghal
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark
| | - Anders Dahl
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Herlev, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.,Clinical Institutes, Copenhagen and Aalborg Universities, A. C. Meyers Vænge 15, 2450 København, Aalborg, Denmark
| | - Kasper Iversen
- Department of Emergency Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørregade 10, 1165 København, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørregade 10, 1165 København, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørregade 10, 1165 København, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, The Heart Center, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 København, Copenhagen, Denmark
| |
Collapse
|
5
|
Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality-a nationwide study. BMC Cardiovasc Disord 2022; 22:338. [PMID: 35906539 PMCID: PMC9336053 DOI: 10.1186/s12872-022-02761-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist.
Methods We included patients with first-time IE (1999–2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999–2003, 2004–2008, 2009–2013, 2014–2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression. Results We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999–2003 to 2014–2018. Compared with 1999–2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96–1.35), OR = 1.20 (95% CI: 1.02–1.42), and OR = 1.10 (95% CI: 0.93–1.29) in 2004–2008, 2009–2013, and 2014–2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999–2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65–1.41), HR = 0.43 (95% CI: 0.28–0.67), and HR = 0.55 (95% CI 0.37–0.83) in 2004–2008, 2009–2013, and 2014–2018, respectively. Conclusions On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02761-z.
Collapse
|
6
|
KÜÇÜK U, ALKAN S, BARUTÇU A. A fatal case of culture-negative late prosthetic mitral valve endocarditis. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1079578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prosthesis valve dehiscence is one of the most serious complications of prosthetic valves. Despite the improvements in medical and surgical treatments, prosthesis valve dehiscence has high mortality. Due to fatality rates, the early diagnosis and treatment of these patients is required. In this case report, we presented a patient with severe mitral deficiency and acute heart failure following mechanical mitral prosthesis valve dehiscence secondary to culture-negative endocarditis.
Collapse
Affiliation(s)
| | - Sevil ALKAN
- Çanakkale On sekiz Mart Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çanakkale
| | | |
Collapse
|
7
|
Beaufrère M, Pressat-Laffouilhère T, Marcelli C, Michon J, Lequerré T, Prum-Delépine C, Fiaux E, Rasoldier V, Etienne M, Savouré A, Dormoy L, Dargère S, Verdon R, Vittecoq O, Avenel G. Valvular and infection-associated risk factors as criteria to guide the use of echocardiography in patients with native joint infections. Semin Arthritis Rheum 2021; 51:1274-1281. [PMID: 34465446 DOI: 10.1016/j.semarthrit.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Native joint and bone infections (NJBI) are associated with infective endocarditis (IE) in 15% of cases. There are no studies analyzing the use of cardiac imaging in cases of NJBI. The objective of this study was to identify factors associated with echocardiography suggestive of IE in patients with NJBI. METHODS This medical records review was conducted in patients hospitalized for NJBI between 2007 and 2017 in Rheumatology and Infectious Diseases departments of 2 university hospitals. Patients included had a microbiologically proven NJBI during their hospitalization. RESULTS In this cohort of 546 patients, median age 66 years, echocardiography was suggestive of IE in 66 (12%). In multivariate analysis, factors associated with echocardiography suggestive of IE were 2 or more positive blood cultures (OR 11.55 (CI95% 3.24-74.20)), cardiac conditions with a high risk of IE (OR 7.34 (CI95% 2.95-18.61)), unknown heart murmur (OR 4.59 (CI95% 1.79-11.74)), multifocal infection (OR 2.26 (CI95% 1.21-4.23)) and an infection due to S. bovis (OR 3.52 (CI95% 1.26-9.79)). The factor associated with the absence of an echocardiography evocative of IE was infection due to unconventional bacteria for IE (OR 0.13 (CI95% 0.01-0.76)). According to the factors associated with echocardiography evocative of IE, we propose the Normandy score based on three kinds of data: cardiac condition, bacterial strain and NJBI mechanism. Echocardiography should be realized when this score, whose negative predictive value is 100% CI95% (98-100%) for prescription of echocardiography, is more than zero. CONCLUSIONS A score based on valvular condition, bacterial strain and NJBI mechanism could guide clinicians in prescribing echocardiography during NJBI with an excellent negative predictive value.
Collapse
Affiliation(s)
- Marie Beaufrère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France.
| | | | - Christian Marcelli
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France
| | - Jocelyn Michon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Thierry Lequerré
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Camille Prum-Delépine
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Elise Fiaux
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Véro Rasoldier
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Manuel Etienne
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Arnaud Savouré
- CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Laurent Dormoy
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Cardiology, 14000 Caen, France
| | - Sylvie Dargère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Renaud Verdon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Olivier Vittecoq
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Gilles Avenel
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| |
Collapse
|
8
|
Bhatnagar R, Rabadia SV, Gupta B, Prosper AE, Ptaszny ME, Shamsa K. Intracardiac Aspergilloma in a Post-Transplant Patient: A Multimodal Approach to Diagnosis. JACC Case Rep 2021; 3:1264-1268. [PMID: 34471875 PMCID: PMC8387809 DOI: 10.1016/j.jaccas.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
Cardiac aspergillomas are rare and associated with high mortality. We present a case of right ventricular cardiac aspergilloma in an asymptomatic renal transplant recipient. Intracavitary aspergilloma is an important consideration in evaluation of an intracardiac mass in an immunocompromised patient. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Roshni Bhatnagar
- Department of Internal Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Soniya V Rabadia
- Department of Internal Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Bali Gupta
- Department of Internal Medicine, University of California-Los Angeles Olive View, Sylmar, California, USA
| | - Ashley E Prosper
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Magdalena E Ptaszny
- Department of Internal Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Kamran Shamsa
- Department of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| |
Collapse
|
9
|
Chaudhari AJ, Badawi RD. Application-specific nuclear medical in vivoimaging devices. Phys Med Biol 2021; 66. [PMID: 33770765 DOI: 10.1088/1361-6560/abf275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/26/2021] [Indexed: 11/11/2022]
Abstract
Nuclear medical imaging devices, such as those enabling photon emission imaging (gamma camera, single photon emission computed tomography, or positron emission imaging), that are typically used in today's clinics are optimized for assessing large portions of the human body, and are classified as whole-body imaging systems. These systems have known limitations for organ imaging, therefore application-specific devices have been designed, constructed and evaluated. These devices, given their compact nature and superior technical characteristics, such as their higher detection sensitivity and spatial resolution for organ imaging compared to whole-body imaging systems, have shown promise for niche applications. Several of these devices have further been integrated with complementary anatomical imaging devices. The objectives of this review article are to (1) provide an overview of such application-specific nuclear imaging devices that were developed over the past two decades (in the twenty-first century), with emphasis on brain, cardiac, breast, and prostate imaging; and (2) discuss the rationale, advantages and challenges associated with the translation of these devices for routine clinical imaging. Finally, a perspective on the future prospects for application-specific devices is provided, which is that sustained effort is required both to overcome design limitations which impact their utility (where these exist) and to collect the data required to define their clinical value.
Collapse
Affiliation(s)
- Abhijit J Chaudhari
- Department of Radiology, University of California Davis, Sacramento, CA 95817, United States of America.,Center for Molecular and Genomic Imaging, University of California Davis, Davis, CA 95616, United States of America
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, Sacramento, CA 95817, United States of America.,Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, United States of America
| |
Collapse
|
10
|
Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
Collapse
|
11
|
Iung B, Tubiana S, Duval X. Towards an increased awareness on infective endocarditis in patients with bloodstream infections: a role for multivariate scores? Eur Heart J 2019; 40:3245-3247. [DOI: 10.1093/eurheartj/ehz408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Collapse
Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, DHU FIRE, Paris, France
- Université de Paris, Paris, France
| | - Sarah Tubiana
- Centre of Clinical Investigations, INSERM 1425, Bichat Hospital, AP-HP, Paris, France
- Université de Paris, IAME, INSERM UMR1137, Paris, France
| | - Xavier Duval
- Centre of Clinical Investigations, INSERM 1425, Bichat Hospital, AP-HP, Paris, France
- Université de Paris, IAME, INSERM UMR1137, Paris, France
| |
Collapse
|