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Palicherla A, Torres R, Walters RW, Thandra A, Narmi A, Smer A. Outcomes of Valvular Endocarditis in Patients With and Without Pericardial Effusion: A National Inpatient Sample Study. Curr Probl Cardiol 2023; 48:101863. [PMID: 37301489 DOI: 10.1016/j.cpcardiol.2023.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Over the last decade, hospitalizations for infective endocarditis (IE) have been steadily increasing, leading to a significant healthcare burden. Pericardial effusion (PCE) has been identified as a serious complication of IE, yet no significant association with mortality has been established. Our study aims to further analyze and understand the significance of PCE in patients with IE. We performed a retrospective analysis using the national inpatient sample database to identify all the hospital admissions with IE using ICD 10 codes and stratified them into 2 groups based on the presence of PCE. The outcomes of interest were inhospital mortality, inhospital complications, need for cardiac surgery, and length of stay. From 2015 Q4-2019, a total of 76,260 hospitalizations were included (weighted: 381,300), of which 2.7% included a PCE diagnosis. Hospitalizations with a PCE diagnosis included patients that were younger (51 vs 61, P < 0.001), as well as slightly more males (58.0% vs 55.2%, P = 0.011), and black patients (16.9% vs 12.9%, P < 0.001). PCE was associated with higher in-hospital death (12.7% vs 9.0%, P < 0.001), longer lengths of stay (12 days vs 7 days, P < 0.001), higher rates of cardiac surgery (22.4% vs 7.3%, P < 0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher on PCE group. We found that presence of PCE is associated with higher inhospital mortality, longer length of stay, and greater utilization of cardiac surgery, as well as presence of heart failure, heart block, cardiogenic shock, and embolic stroke.
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Affiliation(s)
- Anirudh Palicherla
- Department of Medicine, Creighton University School of Medicine, Omaha, NE.
| | - Rosa Torres
- Department of Medicine, Creighton University School of Medicine, Omaha, NE
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Ann Narmi
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Aiman Smer
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
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Youssef GS, Mashaal MS, El Remisy DR, Sorour KA, Rizk HH. Pericardial effusion in prosthetic and native valve infective endocarditis. Indian Heart J 2019; 71:80-84. [PMID: 31000188 PMCID: PMC6477119 DOI: 10.1016/j.ihj.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pericardial effusion (PE) is widely believed to signify more advanced infective endocarditis (IE) and a generally worse outcome. PURPOSE To determine the prevalence and clinical significance of PE in a series of patients with confirmed native and prosthetic valve infections. METHODS Data were collected from 338 consecutive patients with definite or possible IE who visited a single referral center; these patients were examined for the presence of PE as detected by transthoracic echocardiography. Clinical characteristics, the incidence of complications, and outcomes were compared between patients with IE with and without PE. IE patients with PE were then divided into two subgroups: those with and those without cardiac prostheses. RESULTS Eighty-eight patients out of the total 338 (26%) were found to have PE. Compared with patients who did not have PE, patients who did were significantly younger (32.9 ± 13.4 vs 29.0 ± 9.2, p = 0.003), had more left-sided vegetation (55.6% vs 77.3%, p < 0.001), more root abscesses (9.2% vs 25.0%, p < 0.001), needed surgery more frequently (68.0% vs 84.1%, p = 0.001), and had a higher mortality rate (22.0% vs 32.9%, p = 0.03). PE was not found to be a predictor of mortality. No significant difference was found between IE patients with PE with (n = 13) and without (n = 75) prostheses with regard to causative organisms, clinical characteristics, or clinical outcomes. CONCLUSION Regardless of whether the IE was in native or prosthetic valves, compared with patients without PE, patients with PE had more severe infections and a worse prognosis, but PE was not an independent predictor of mortality.
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Affiliation(s)
- Ghada S Youssef
- Cardiology Department, Faculty of Medicine, Cairo University, Cairo 11411, Egypt.
| | - Marwa S Mashaal
- Cardiology Department, Faculty of Medicine, Cairo University, Cairo 11411, Egypt
| | - Dalia R El Remisy
- Cardiology Department, Faculty of Medicine, Cairo University, Cairo 11411, Egypt
| | - Khalid A Sorour
- Cardiology Department, Faculty of Medicine, Cairo University, Cairo 11411, Egypt
| | - Hussein H Rizk
- Cardiology Department, Faculty of Medicine, Cairo University, Cairo 11411, Egypt
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Risk factors of pericardial effusion in native valve infective endocarditis and its influence on outcome: A multicenter prospective cohort study. Int J Cardiol 2018; 273:193-198. [PMID: 30122503 DOI: 10.1016/j.ijcard.2018.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/26/2018] [Accepted: 08/04/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pericardial effusion is a frequent finding in the setting of infective endocarditis. Limited data exists on clinical characteristics and outcomes in this group of patients. We aimed to determine the associated factors, clinical characteristics, and outcomes of patients who had pericardial effusion and native valve infective endocarditis. METHODS AND RESULTS A total of 1205 episodes of infective endocarditis from 25 Spanish centers between June 2007 and March 2013 within the Spanish Collaboration on Endocarditis (GAMES) registry were included. Echocardiogram at admission, clinical and microbiological variables, and one-year follow-up were analyzed. Pericardial effusion was observed in 7.8% (94/1205 episodes) of episodes of infective endocarditis, most of them being mild or moderate (93.6%). The presence of pericardial effusion was associated with a higher risk of heart failure during admission (OR 1.9; CI 95% 1.2-3.0). Patients with pericardial effusion had a higher rate of surgery (53.2% vs. 41.1%; p = 0.02); however, this association was no longer significant after adjusting for possible confounders (OR 1.4; CI 95% 0.9-2.2; p = 0.10). The presence of pericardial effusion was not associated with a higher in-hospital or one-year mortality (33.0% vs. 25.2%; p = 0.10 and 40.2% vs. 37.3%; p = 0.60 respectively). CONCLUSIONS The prevalence of pericardial effusion in patients with infective endocarditis was lower than previously reported. The presence of pericardial effusion is associated with the development of heart failure during hospitalization making it a warning sign, possibly reflecting indirectly a mechanical complication, which, however, if treated surgically in a timely manner does not change the final outcome of patients.
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You SC, Shim CY, Hong GR, Kim D, Cho IJ, Lee S, Chang HJ, Ha JW, Chang BC, Chung N. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery. PLoS One 2016; 11:e0165754. [PMID: 27855225 PMCID: PMC5113894 DOI: 10.1371/journal.pone.0165754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/17/2016] [Indexed: 12/19/2022] Open
Abstract
This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.
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Affiliation(s)
- Seng Chan You
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Geu-Ru Hong
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Darae Kim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Jeong Cho
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck-Jae Chang
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Chul Chang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Namsik Chung
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sivak JA, Vora AN, Navar AM, Schulte PJ, Crowley AL, Kisslo J, Corey GR, Liao L, Wang A, Velazquez EJ, Samad Z. An Approach to Improve the Negative Predictive Value and Clinical Utility of Transthoracic Echocardiography in Suspected Native Valve Infective Endocarditis. J Am Soc Echocardiogr 2016; 29:315-22. [PMID: 26850679 PMCID: PMC6052444 DOI: 10.1016/j.echo.2015.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with suspected native valve infective endocarditis, current guidelines recommend initial transthoracic echocardiography (TTE) followed by transesophageal echocardiography (TEE) if clinical suspicion remains. The guidelines do not account for the quality of initial TTE or other findings that may alter the study's diagnostic characteristics. This may lead to unnecessary TEE when initial TTE was sufficient to rule out vegetation. METHODS The objective of this study was to determine if the use of a strict definition of negative results on TTE would improve the performance characteristics of TTE sufficiently to exclude vegetation. A retrospective analysis of patients at a single institution with suspected native valve endocarditis who underwent TTE followed by TEE within 7 days between January 1, 2007, and February 28, 2014, was performed. Negative results on TTE for vegetation were defined by either the standard approach (no evidence of vegetation seen on TTE) or by applying a set of strict negative criteria incorporating other findings on TTE. Using TEE as the gold standard for the presence of vegetation, the diagnostic performance of the two transthoracic approaches was compared. RESULTS In total, 790 pairs of TTE and TEE were identified. With the standard approach, 661 of the transthoracic studies had negative findings (no vegetation seen), compared with 104 studies with negative findings using the strict negative approach (meeting all strict negative criteria). The sensitivity and negative predictive value of TTE for detecting vegetation were substantially improved using the strict negative approach (sensitivity, 98% [95% CI, 95%-99%] vs 43% [95% CI, 36%-51%]; negative predictive value, 97% [95% CI, 92%-99%] vs 87% [95% CI, 84%-89%]). CONCLUSIONS The ability of TTE to exclude vegetation in patients is excellent when strict criteria for negative results are applied. In patients at low to intermediate risk with strict negative results on TTE, follow-up TEE may be unnecessary.
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Affiliation(s)
- Joseph A Sivak
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amit N Vora
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Ann Marie Navar
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Anna Lisa Crowley
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph Kisslo
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - G Ralph Corey
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Lawrence Liao
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Eric J Velazquez
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Zainab Samad
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Regueiro A, Falces C, Cervera C, del Rio A, Paré JC, Mestres CA, Castañeda X, Pericàs JM, Azqueta M, Marco F, Ninot S, Almela M, Moreno A, Miró JM. Risk factors for pericardial effusion in native valve infective endocarditis and its influence on outcome. Am J Cardiol 2013; 112:1646-51. [PMID: 24055065 DOI: 10.1016/j.amjcard.2013.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 12/20/2022]
Abstract
Data on the incidence, associated factors, and prognosis of pericardial effusion (PE) in patients with infective endocarditis (IE) are scarce. Patients with native valve IE were prospectively followed in our center from 1990 to 2007. A logistic regression analysis was performed to identify independent variables associated with PE and mortality. We included 479 episodes of IE from 459 patients (70% men, mean age 51 years). Small-to-moderate PE was observed in 109 episodes (23%) and large-to-very large PE was observed in 9 episodes (2%). Patients with small-to-moderate PE had a greater prevalence of intravenous drug use (38% vs 23%) and more frequent right-sided IE than patients without PE (33% vs 17%). Patients with large-to-very large PE had a higher rate of systemic emboli (22% vs 18%) and periannular abscess (22% vs 6%) than patients without PE. Renal failure was associated with a higher risk of PE (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3 to 3.3); age was associated with a lower risk of PE (OR 0.98, 95% CI 0.97 to 0.99). One-year mortality of patients with IE with large-to-very large PE was higher than that of patients with small-to-moderate and absence of PE (56%, 18%, and 24%, respectively, p = 0.033). Large-to-very large PE increases the 1-year mortality of IE (OR 3.0, 95% CI 1.2 to 7.9). In conclusion, renal failure and younger age are associated with a higher risk of PE. Large-to-very large PE was associated with an increase in 1-year mortality.
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Katz LH, Pitlik S, Porat E, Biderman P, Bishara J. Pericarditis as a presenting sign of infective endocarditis: two case reports and review of the literature. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2008; 40:785-791. [PMID: 18609201 DOI: 10.1080/00365540802169106] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pericarditis as a presenting sign of infective endocarditis is rare. Here we describe 2 cases and an additional 19 cases of pericarditis as a presenting sign of infective endocarditis reported during the last 40 y. 71% of patients were young males (mean age 43.2 y). The most commonly reported underlying conditions were diabetes mellitus type 2 (5 patients, 24%), and substance or alcohol abuse (4 patients, 19%). The native aortic valve was the most frequently involved valve. The most common symptoms were fever, cough or dyspnoea, and chest pain. Overt tamponade was diagnosed in 47% of the patients. However, pulsus paradoxus and pericardial friction rub were rare. A heart murmur was heard in 12 patients (57%). Staphylococcus aureus was the most commonly isolated pathogen concomitantly from blood and pericardial fluid. 16 patients (76%) were operated. Six underwent a pericardial procedure, 5 underwent valve replacement, 4 both, and 1 patient was operated for pseudoaneurysm. Mortality rates were 60% and 31% of patients treated with antibiotics alone versus antibiotics and surgical intervention, respectively. In patients presenting with pericarditis with or without cardiac tamponade, the possibility of infective endocarditis should be considered. Optimal therapy should consist of antibiotics and surgical intervention.
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Affiliation(s)
- Lior H Katz
- Infectious Diseases Unit, Department of Internal Medicine D, Rabin Medical Centre, Beilinson Hospital, Petah Tiqwa, Israel
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Chang K, Seung KB, Shin WS, Kim PJ, Ihm SH, Lee DG, Kim JH, Hong SJ, Choi KB. Infective endocarditis of the aortic valve complicated by massive pericardial effusion and rupture of a sinus of valsalva into the right atrium. J Am Soc Echocardiogr 2004; 17:910-2. [PMID: 15282499 DOI: 10.1016/j.echo.2004.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Infective endocarditis (IE) of the aortic valve is most commonly associated with perivalvular invasion and intracardiac fistula formation, which sometimes give rise to unpredictable clinical events. Massive pericardial effusion and aorticocardiac fistula are very rare complications of IE. We present a case in which IE of the aortic valve was initially associated with massive pericardial effusion requiring drainage and later complicated by rupture of a sinus of Valsalva with a fistula into the right atrium without formation of aneurysm. To our knowledge, the concurrent occurrence of these two events in a patient with IE has not been previously reported.
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Affiliation(s)
- Kiyuk Chang
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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Mügge A, Daniel WG. Echocardiographic assessment of vegetations in patients with infective endocarditis: prognostic implications. Echocardiography 1995; 12:651-61. [PMID: 10158102 DOI: 10.1111/j.1540-8175.1995.tb00858.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Today, echocardiography is the most important technique next to clinical findings and blood cultures in the diagnosis of infective endocarditis. The sensitivity of echocardiography, particularly the transesophageal approach, for detection of vegetations and endocarditis related valvular destructions is high. In addition, echocardiographic findings may have some prognostic implications. The size and mobility of vegetations stratifies endocarditis patients into a high risk group for arterial embolism. In particular, mobile vegetations attached to the mitral valve with a maximal diameter > 10 mm may be prone to embolic events. Furthermore, increase in size of vegetations during antimicrobial treatment may identify patients with no, or at least a prolonged, healing process. Also, a lack of increase in the echo density of vegetations under adequate antibiotic treatment may indicate a poor healing process and may necessitate more aggressive management. The demonstration of paravalvular abscesses by echocardiography, particularly by transesophageal echocardiography, identifies a subgroup of patients who will need urgent cardiac surgery before widespread tissue destruction has occurred.
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Affiliation(s)
- A Mügge
- Department of Internal Medicine, Hannover Medical School, Germany
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Mügge A. ECHOCARDIOGRAPHIC DETECTION OF CARDIAC VALVE VEGETATIONS AND PROGNOSTIC IMPLICATIONS. Infect Dis Clin North Am 1993. [DOI: 10.1016/s0891-5520(20)30564-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nottestad SY, Mascette AM. Loculated pericardial effusion and cardiac tamponade late after cardiac surgery. Chest 1992; 101:852-3. [PMID: 1541158 DOI: 10.1378/chest.101.3.852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A case of loculated pericardial effusion diagnosed by chest roentgenogram and subsequent echocardiogram is presented. This effusion was unusual in its late appearance after thoracotomy and its discrete location which resulted in hemodynamic embarrassment. Subsequent cultures demonstrated an infected pericardial space and septicemia.
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Affiliation(s)
- S Y Nottestad
- Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Wash
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