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Kildahl HA, Brenne EL, Dalen H, Wahba A. Systemic embolization in infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:40-46. [PMID: 38827555 PMCID: PMC11139814 DOI: 10.1007/s12055-023-01616-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 06/04/2024] Open
Abstract
Embolism is a common complication in infective endocarditis which may lead to serious complications, such as stroke, intestinal ischemia, and peripheral embolization. A comprehensive literature search was performed and the registry at our centre, including 390 cases of infective endocarditis, diagnosed between 2010 and 2020, was investigated. Large registries show that 20-40% of patients with infective endocarditis (IE) are affected by embolism. In many instances, embolism is present already at the time of diagnosis. The rate of embolism during the hospital stay in our data was 11%. However, only 2% developed clinical embolism during or following surgery. According to recent guidelines, previous embolism, and the presence of vegetations > 10 mm present an indication for surgical treatment. Routine imaging revealed non-symptomatic cerebral embolism in 8.5% of surgical patients. However, it is not clear whether detection of non-symptomatic embolism and consecutive surgical treatment improves the prognosis of infective endocarditis.
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Affiliation(s)
- Henrik Agerup Kildahl
- Department of Cardiothoracic Surgery, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
| | | | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Department of Cardiology, St Olavs Hospital, Trondheim, Norway
| | - Alexander Wahba
- Department of Cardiothoracic Surgery, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
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2
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Tisch C, Ernst D, Falke M, Speicher P, Ziaka M. Systemic embolization due to non-bacterial thrombotic endocarditis: An autopsy case report and mini review of the literature. SAGE Open Med Case Rep 2024; 12:2050313X241229576. [PMID: 38292877 PMCID: PMC10826374 DOI: 10.1177/2050313x241229576] [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: 08/28/2023] [Accepted: 01/12/2024] [Indexed: 02/01/2024] Open
Abstract
Nonbacterial thrombotic endocarditis is a rare, non-infectious complication associated with hypercoagulable states, such as malignancies and autoimmune diseases. Due to the difficulty distinguishing marantic endocarditis from infective endocarditis, the diagnosis is often delayed or even a postmortem finding. We present the case of a 70-year-old Caucasian female with marantic endocarditis secondary to metastatic duodenal adenocarcinoma. The patient presented with a short history of memory deficits, personality disturbances, and left homonymous hemianopia. Diffusion-weighted magnetic resonance imaging showed multi-territorial bihemispheric cerebral infarctions. Transthoracic echocardiography revealed native mitral valve endocarditis, and serial blood cultures remained negative. Despite antibiotic therapy, the patient's condition continuously deteriorated, and she died within 3 weeks after her initial presentation. Postmortem examination showed a non-bacterial thrombotic endocarditis. Early clinical suspicion and prompt diagnosis are of decisive importance for the survival of the patients.
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Affiliation(s)
- Carmen Tisch
- Department of Internal Medicine, Hospital of Thun, Thun, Switzerland
| | - Daniel Ernst
- Department of Internal Medicine, Hospital of Thun, Thun, Switzerland
| | - Monika Falke
- University of Bern, Institute of Tissue Medicine and Pathology, Bern, Switzerland
| | - Philip Speicher
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mairi Ziaka
- Department of Internal Medicine, Hospital of Thun, Thun, Switzerland
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3
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Li N, Zhang T, Zhu L, Sun L, Shao G, Gao J. Recent Advances of Using Exosomes as Diagnostic Markers and Targeting Carriers for Cardiovascular Disease. Mol Pharm 2023; 20:4354-4372. [PMID: 37566627 DOI: 10.1021/acs.molpharmaceut.3c00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of human death worldwide. Exosomes act as endogenous biological vectors; they possess advantages of low immunogenicity and low safety risks, also providing tissue selectivity, including the inherent targeting the to heart. Therefore, exosomes not only have been applied as biomarkers for diagnosis and therapeutic outcome confirmation but also showed potential as drug carriers for cardiovascular targeting delivery. This review aims to summarize the progress and challenges of exosomes as novel biomarkers, especially many novel exosomal noncoding RNAs (ncRNAs), and also provides an overview of the improved targeting functions of exosomes by unique engineered approaches, the latest developed administration methods, and the therapeutic effects of exosomes used as the biocarriers of medications for cardiovascular disease treatment. Also, the possible therapeutic mechanisms and the potentials for transferring exosomes to the clinic for CVD treatment are discussed. The advances, in vivo and in vitro applications, modifications, mechanisms, and challenges summarized in this review will provide a general understanding of this promising strategy for CVD treatment.
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Affiliation(s)
- Ni Li
- Department of Cardiothoracic Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315041, China
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Tianyuan Zhang
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Linwen Zhu
- Department of Cardiothoracic Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315041, China
| | - Lebo Sun
- Department of Cardiothoracic Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315041, China
| | - Guofeng Shao
- Department of Cardiothoracic Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315041, China
| | - Jianqing Gao
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
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4
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Covino M, De Vita A, d'Aiello A, Ravenna SE, Ruggio A, Genuardi L, Simeoni B, Piccioni A, De Matteis G, Murri R, Leone AM, Flex A, Gasbarrini A, Liuzzo G, Massetti M, Franceschi F. A New Clinical Prediction Rule for Infective Endocarditis in Emergency Department Patients With Fever: Definition and First Validation of the CREED Score. J Am Heart Assoc 2023; 12:e027650. [PMID: 37119081 PMCID: PMC10227214 DOI: 10.1161/jaha.122.027650] [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: 09/19/2022] [Accepted: 02/23/2023] [Indexed: 04/30/2023]
Abstract
Background Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy-to-use clinical prediction score for the diagnosis of IE in the ED. Methods and Results We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56-81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849-0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848-0.913) in the validation cohort, not significantly different from the one calculated in the retrospective cohort (P=0.578). Conclusions In this study, we propose and prospectively validate the CREED score, a clinical prediction rule for the diagnosis of IE in patients with fever admitted to the ED. Our data reflect the difficulty of creating a meaningful tool able to identify patients with IE among this general and heterogeneous population because of the complexity of the disease and its low prevalence in the ED setting.
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Affiliation(s)
- Marcello Covino
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
| | - Antonio De Vita
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Alessia d'Aiello
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | | | - Aureliano Ruggio
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Lorenzo Genuardi
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Benedetta Simeoni
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Andrea Piccioni
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Giuseppe De Matteis
- Department of Internal MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Rita Murri
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Infectious DiseaseFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Antonio Maria Leone
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Andrea Flex
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Antonio Gasbarrini
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Internal MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Giovanna Liuzzo
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Massimo Massetti
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Francesco Franceschi
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
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Rahouma M, Khairallah S, Dabsha A, Elkharbotly IAMH, Baudo M, Ismail A, Korani OM, Hossny M, Dimagli A, Girardi LN, Mick SL, Gaudino M. Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients' Data. Cancers (Basel) 2023; 15:cancers15061848. [PMID: 36980734 PMCID: PMC10047261 DOI: 10.3390/cancers15061848] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21-0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13-0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61-0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56-0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with 6-month OS of 20.8% vs. 37.0% in lung vs. other cancers, respectively (p = 0.06) and 42.9% vs. 31.1% among those who underwent intervention vs. those who did not (p = 0.07). Cases discovered in recent years had better survival (HR = 0.98 (95% CI, 0.96-0.99; p = 0.003). While cancer-associated NBTE is a rare entity, lung cancers were the most common tumor site and are frequently associated with more advanced and metastatic cancer stages. The prognosis is dismal, especially among lung cancers.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Sherif Khairallah
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Anas Dabsha
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Ismail A M H Elkharbotly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
- General Surgery Department, Newham University Hospital, London E13 8SL, UK
| | - Massimo Baudo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Cardiac Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amr Ismail
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Omnia M Korani
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mohamed Hossny
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
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6
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Damlin A, Eriksson MJ, Maret E. Can transthoracic echocardiography be used to a greater extent in the diagnostics of infective endocarditis to avoid unnecessary transoesophageal examinations without jeopardising accuracy? Cardiovasc Ultrasound 2023; 21:3. [PMID: 36717895 PMCID: PMC9887897 DOI: 10.1186/s12947-023-00301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious condition that requires prompt diagnosis and treatment. Transthoracic echocardiography (TTE) is usually the initial imaging modality, however transoesophageal echocardiography (TOE) is sometimes necessary because of its higher sensitivity for IE. Yet, TOE may imply an increased risk of complications. This project aims to evaluate whether TTE can be used to a greater extent in the diagnostics of IE to avoid unnecessary TOE examinations without jeopardizing diagnostic accuracy. METHODS Data from all TOE examinations performed on patients hospitalized with clinical suspicion of IE between 2019-05-01 and 2020-04-30 at a university hospital in Stockholm, Sweden, were obtained and analysed. Variables included for analysis were age, sex, blood culture results, aetiology, results from TOE, number of TOEs during the inclusion period, results from positron emission tomography/computed tomography (PET/CT), new regurgitation, cardiac murmur, previous IE, prosthetic valve, predisposing factors, i.e. cardiac comorbidities, injection drug use, fever, vascular phenomena, and immunological phenomena. To assess associations between predisposing factors or aetiology of IE and TOE findings, chi square tests and logistic regression models were used. For continuous variables, linear regression was used for comparisons of means and quantile regression was used for comparisons of medians. P < 0.05 was considered significant. RESULTS In total 195 TOE examinations (Table 1) from 160 patients were included, of which 61 (31%) were positive for IE. In total, 36 examinations had negative TTE prior to TOE of which 32 (86%) also had negative TOE. Of the 5 (14%) negative TTE prior to TOE that had positive TOE, all had cardiovascular implantable electronic device (CIED) and/or prosthetic valves. CONCLUSIONS The existing recommendations for TOE in patients with clinical suspicion of IE are probably broad enough not to miss patients with IE, but there might be an unnecessarily large number of patients being referred for TOE with negative results. Negative TTE examination with good image quality and no CIED or prosthetic valves, may be sufficient without jeopardizing the IE diagnosis.
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Affiliation(s)
- Anna Damlin
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), Stockholm, 171 76 Sweden ,grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, Solna, A8:01, Eugeniavägen 3, Stockholm, SE-171 76 Sweden
| | - Maria J. Eriksson
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), Stockholm, 171 76 Sweden ,grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, Solna, A8:01, Eugeniavägen 3, Stockholm, SE-171 76 Sweden
| | - Eva Maret
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), Stockholm, 171 76 Sweden ,grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, Solna, A8:01, Eugeniavägen 3, Stockholm, SE-171 76 Sweden
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Ivanovic B, Popovic J, Dukic D, Petkovic A, Petrovic O. The role of imaging in infective endocarditis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1060-1065. [PMID: 36218208 DOI: 10.1002/jcu.23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Infective endocarditis (IE) poses a large diagnostic and therapeutical challenge. An early diagnosis is necessary for a positive outcome. Echocardiography is initial diagnostic method when there is a possibility of IE presence. TTE and TEE are useful in detection, accurate localisation and estimation of vegetation size, and also in detection of paravalvular spreading of infection. In certain situations, there is a need for usage of complementary methods like CCT and nuclear techniques. This article will outline advantages and limitations of certain diagnostic methods in diagnosis of IE.
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Affiliation(s)
- Branislava Ivanovic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Popovic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Djordje Dukic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana Petkovic
- Center of Radiology and MRI, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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Quintero-Martinez JA, Hindy JR, El Zein S, Michelena HI, Nkomo VT, DeSimone DC, Baddour LM. Contemporary demographics, diagnostics and outcomes in non-bacterial thrombotic endocarditis. Heart 2022; 108:heartjnl-2022-320970. [PMID: 35534050 DOI: 10.1136/heartjnl-2022-320970] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/14/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Non-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients. METHODS Adults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up. RESULTS Forty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively). CONCLUSIONS NBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.
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Affiliation(s)
- Juan A Quintero-Martinez
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Joya-Rita Hindy
- Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Said El Zein
- Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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9
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Silbiger JJ, Rashed E, Chen H, Wiesenfeld E, Robinson SE, Cagliostro M. Cardiac Imaging for Diagnosis and Management of Infective Endocarditis. J Am Soc Echocardiogr 2022; 35:910-924. [PMID: 35487472 DOI: 10.1016/j.echo.2022.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022]
Abstract
Imaging is central to the care of patients with infective endocarditis. While transthoracic and transesophageal echocardiography are the principle imaging techniques, additional modalities including positron emission tomography and cardiac computed tomography, and to a lesser extent intracardiac echocardiography, play an increasing role. This review discusses the role of cardiac imaging in establishing the diagnosis of endocarditis, in predicting its embolic risk and in making decisions regarding the need for and timing of surgery.
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Affiliation(s)
| | - Eman Rashed
- Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - Huazhen Chen
- Icahn School of Medicine at Mount Sinai, New York, N.Y
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10
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Bugariu M, Tilkorn D, Hauser J, Bienek M. [Complete Occlusion of the radial Artery by a cardiogenic Embolus in infective Endocarditis]. HANDCHIR MIKROCHIR P 2022; 54:163-166. [PMID: 35419786 DOI: 10.1055/a-1750-9362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of septic embolization of the right radial artery by a cardiogenic embolus resulting from infective endocarditis. After the first suspicion of a palmar forearm phlegmon due to tenosynovitis was voiced, surgery revealed a long-segment occlusion of the radial artery. We resected the thrombosed part of the artery and reconstructed the latter with a vein interposition graft. Further diagnostic evaluation by echocardiography revealed vegetations on the anterior mitral leaflet. Reconstruction of the mitral valve was performed by annuloplasty.
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Affiliation(s)
- Marios Bugariu
- Florence Nightingale Hospital, Plastische und Ästhetische Chirurgie
| | - Daniel Tilkorn
- Alfried-Krupp-Krankenhaus Essen, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Handchirurgie
| | - Joerg Hauser
- Alfried-Krupp-Krankenhaus Essen, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Handchirurgie
| | - Markus Bienek
- Alfried-Krupp-Krankenhaus Essen, Klinik für Kardiologie
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11
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Mills MT, Al-Mohammad A, Warriner DR. Changes and advances in the field of infective endocarditis. Br J Hosp Med (Lond) 2022; 83:1-11. [DOI: 10.12968/hmed.2021.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. Thus, patients with infective endocarditis may first present to the acute or general physician, who may have a variable knowledge of the condition. The diagnosis of infective endocarditis can be challenging, relying on clinical, imaging and microbiological features. Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David R Warriner
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Koito S, Unoki Y, Yoshida K, Takemoto S, Uchida T, Matono T. Importance of early diagnosis and surgical treatment of calcified amorphous tumor-related native valve endocarditis caused by Escherichia coli: a case report. BMC Infect Dis 2022; 22:226. [PMID: 35255861 PMCID: PMC8900428 DOI: 10.1186/s12879-022-07220-w] [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: 05/17/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unlike Escherichia coli bacteremia, which is common, E. coli endocarditis is uncommon, particularly in patients with native valve, leading to its delayed diagnosis. CASE PRESENTATION We present a case of infective endocarditis caused by E. coli in a 78-year-old Japanese man with type 2 diabetes, involving persistent bacteremia and vegetation on the mitral valve (measuring 18 × 4.2 mm in diameter). He presented with recurrent fever after antimicrobial treatment for pyelonephritis. He received antibiotic therapy for 6 weeks and required surgical removal of a calcified amorphous tumor and vegetation with mitral valvuloplasty 7 days after admission. Despite an episode of multiple cerebral infarctions, he recovered fully from the infection. CONCLUSIONS Follow-up blood cultures should be performed for Gram-negative bacilli bacteremia among patients with unknown focus and an atypical clinical course after treatment. Early diagnosis and aggressive surgical intervention are paramount to achieving good clinical outcomes.
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Affiliation(s)
- Shu Koito
- Department of General Internal Medicine, Aso Iizuka Hospital, Iizuka, Japan
| | - Yuto Unoki
- Department of General Internal Medicine, Aso Iizuka Hospital, Iizuka, Japan
| | - Keimei Yoshida
- Department of Cardiology, Aso Iizuka Hospital, Iizuka, Japan
| | - Sho Takemoto
- Department of Cardiovascular Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Takayuki Uchida
- Department of Cardiovascular Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Takashi Matono
- Department of Infectious Diseases, Aso Iizuka Hospital, 3-83 Yoshio, Iizuka, Fukuoka, 820-8505, Japan.
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Paras ML, Jassar AS. Vegetation size in patients with infective endocarditis: does size matter? J Am Soc Echocardiogr 2022; 35:576-578. [DOI: 10.1016/j.echo.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
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Arora N, Panda PK, Cr P, Uppal L, Saroch A, Angrup A, Sharma N, Sharma YP, Vijayvergiya R, Rohit MK, Gupta A, Sihag BK, Gupta H, Dahiya N, Bahl A, Singh P, Mehrotra S, Barwad P, Pannu AK. Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India. Indian Heart J 2021; 73:711-717. [PMID: 34861981 PMCID: PMC8642647 DOI: 10.1016/j.ihj.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design A retrospective analysis of patients with in north India between 2010 and 2020. Methods The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed. Results The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005). Conclusion IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.
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Affiliation(s)
- Navneet Arora
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Prashant Kumar Panda
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pruthvi Cr
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Lipi Uppal
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Atul Saroch
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Archana Angrup
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Yash Paul Sharma
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ankur Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhupinder Kumar Sihag
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Himanshu Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Neelam Dahiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parminder Singh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Saurabh Mehrotra
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parag Barwad
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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15
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AlBassri T, Sheikho M, Chaikhouni F, Al Habshan F, Kabbani MS. Neurological complications in children with infective endocarditis: Incidence, risk factors, and outcome: A 10-year single-center experience. Int J Pediatr Adolesc Med 2021; 8:198-202. [PMID: 34350336 PMCID: PMC8319676 DOI: 10.1016/j.ijpam.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/26/2020] [Accepted: 02/14/2021] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite improvement in medical management, infective endocarditis (IE) remains a serious disease that may affect children with and without preexisting cardiac conditions with significant morbidity and mortality. Neurological complications of IE represent the worst with guarded prognosis. The aim of this study is to describe the incidence, etiology, characteristics, risk factors, and outcome of children with neurological complications associated with IE. MATERIAL AND METHODS A retrospective cohort study was conducted from 2009 to 2019 where all pediatric patients who fulfilled the modified Duke criteria for IE were included. We divided the cases into 2 groups: IE with neurological complications and IE without neurological complications control group. We compared the two groups statistically and analyzed the results. RESULTS We identified 31 (17 male, 14 female) patients with IE. Neurological complications occurred in 7/31 (23%) patients, mainly in the form of a stroke. Gram-positive microbes were the main causative agents for IE (52%) followed by gram-negative (14%), then fungal organisms (3%). Univariate analysis identified the following risk factors for neurological complications: lower body weight, higher C- reactive protein (CRP) level, and left-sided valvular lesions with P values of (0.0003, 0.0001, and 0.04), respectively.Although mortality was higher in the neurological complications group, it was 43% in comparison to 21% in the control group and it did not reach statistical significance (P = .49). Large vegetation size (more than 10 mm) was seen in 57% of patients with neurological complications as compared to 16% in the control group (P = .052). CONCLUSION Neurological complications occurred in almost a quarter of children with IE. Possible risk factors include lower body weight, left-sided valvular lesion, and higher levels of inflammatory markers (CRP). Stroke was the most common neurological complication encountered with possible increased risk of mortality.
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Affiliation(s)
- Tala AlBassri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maha Sheikho
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farah Chaikhouni
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Al Habshan
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed S. Kabbani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Pediatric Cardiac Intensive Care, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Corresponding author. Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, P.O. BOX 22490, Riyadh, 11426, Saudi Arabia.
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16
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Perrin T, Deharo JC. Therapy and outcomes of cardiac implantable electronic devices infections. Europace 2021; 23:iv20-iv27. [PMID: 34160599 PMCID: PMC8221052 DOI: 10.1093/europace/euab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiac implantable electronic device (CIED) infection causes significant morbidity and mortality without appropriate treatment. It can present as incisional infection, pocket infection, systemic CIED infection, or occult bacteraemia. Complete percutaneous CIED extraction (excepted in case of incisional infection) and appropriate antibiotic therapy are the two main pillars of therapy. Device reimplantation, if needed, should be delayed sufficiently to allow control of the infection. Here, we address the differences in prognosis according to the clinical scenario and the different treatment options.
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Affiliation(s)
- Tilman Perrin
- Department of Cardiology, Solothurner Spitäler Bürgerspital, Solothurn, Switzerland.,Department of Cardiology, Centre Hospitalier Universitaire La Timone, 264 Rue Saint-Pierre, F-13005 Marseille, France
| | - Jean-Claude Deharo
- Department of Cardiology, Centre Hospitalier Universitaire La Timone, 264 Rue Saint-Pierre, F-13005 Marseille, France
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17
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Holte E, Dweck MR, Marsan NA, D'Andrea A, Manka R, Stankovic I, Haugaa KH. EACVI survey on the evaluation of infective endocarditis. Eur Heart J Cardiovasc Imaging 2021; 21:828-832. [PMID: 32361725 PMCID: PMC7369685 DOI: 10.1093/ehjci/jeaa066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Aims To evaluate the diagnosis and imaging of patients with suspected endocarditis and the management in routine clinical practice across Europe, the EACVI Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of echocardiography, advanced imaging modalities and multidisciplinary team was explored. Methods and results A total of 100 European Echocardiography Laboratories from 29 different countries responded to the survey, which consisted of 20 questions. For most of the use of echocardiography and advanced imaging, answers from the centres were relatively homogeneous and demonstrated good adherence to current recommendations. In particular, two-thirds of centres report the use of a specific endocarditis team for decision-making. Echocardiography plays a key role in the diagnosis and management of endocarditis. Nuclear imaging modalities are broadly available among the centres and are mainly used in prosthetic valve endocarditis and cardiac device-related infective endocarditis. Computed tomography (CT) is widely available and used to assess for structural valve abnormalities, neurological complications, and to preoperative assessment of the coronary arteries. Most institutions provide structured patients follow-up following hospital discharge. Conclusion In Europe, a relatively homogenous adherence to current recommendation was observed for most diagnostic and management including the follow-up of patients with endocarditis. Decision-making is most commonly performed by a multidisciplinary team. Echocardiography remains the first line and central imaging modality for patient diagnosis and assessment, but 60% of centres also commonly use CT, whilst positron emission tomography imaging is used in patients with prosthetic valve endocarditis or device infection.
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Affiliation(s)
- Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, PO Box 3250, Torgarden, 7006 Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, PO Box 8905, 7491 Trondheim, Norway
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Alegria S, Marques A, Cruz I, Broa AL, Pereira ARF, João I, Simões O, Pereira H. Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre. Arq Bras Cardiol 2021; 116:682-691. [PMID: 33886711 PMCID: PMC8121414 DOI: 10.36660/abc.20190586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022] Open
Abstract
Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.
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Affiliation(s)
- Sofia Alegria
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Ana Marques
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Inês Cruz
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Ana Luísa Broa
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | | | - Isabel João
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Otília Simões
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Hélder Pereira
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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20
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Hassan AY, Kassem HH, Kandil HI, Meshaal MS, Salem MA, Mohamed AS. Impact of Cardiac Computed Tomographic Angiography on Diagnostic and Therapeutic Decisions in Patients with Suspected Prosthetic Heart Valve Dysfunction. J Saudi Heart Assoc 2021; 33:85-94. [PMID: 33936942 PMCID: PMC8084306 DOI: 10.37616/2212-5043.1231] [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: 09/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Computed Tomography (CT) scan is a helpful tool to assess the coronary arteries and the great vessels. However, its routine use in the assessment of patients with suspected prosthetic valve dysfunction (PVD) has not been studied thoroughly. Objective To determine the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD. Methods and results This was a prospective cohort study that was conducted on 50 consecutive patients with suspected PVD who underwent both 64-slice ECG-gated CT and transesophageal echocardiography (TEE). The gold standard was the intraoperative findings. Surgery was performed in forty-six patients. ECG-gated CT showed findings that were not detected by TEE in sixteen patients (32%) namely aortic root abscess, aortic pseudoaneurysm, paravalvular leakage (PVL), sclero-calcific disruption of sutures as cause of PVL, mechanical prosthesis occluder malfunction, an underlying thrombus as cause of malfunction and finally presence of aortic dissection. Furthermore, CTA findings dictated treatment changes in fourteen patients (28%). Conclusion This study demonstrates that ECG-gated CTA has a complementary role to TEE in patients with suspected PVD. CCTA is more accurate in diagnosis of periannular complications (Aortic root abscess and Pseudo-aneurysm) and in delineating their anatomical relation to surrounding cardiac structures. Therefore CCTA can have important role in deciding and planning the method of correction whether surgical or percutaneous and has to be considered after TEE in patients with a high suspicion on PVD.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 517] [Impact Index Per Article: 172.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 316] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 720] [Impact Index Per Article: 240.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Diagnostic value of the modified Duke criteria in suspected infective endocarditis -The PRO-ENDOCARDITIS study. Int J Infect Dis 2021; 104:556-561. [PMID: 33508475 DOI: 10.1016/j.ijid.2021.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To determine whether relevant comorbidities stratify patients with and without IE and whether these may improve the diagnostic accuracy, in addition to the modified Duke criteria. METHODS AND RESULTS 261 consecutive patients (aged 60.1 ± 16.1 years, 62.8% male) with suspected IE were prospectively included in this single-center observational trial. Modified Duke criteria and relevant comorbidities as well as clinical characteristics, were assessed. Forty-seven patients had IE, as confirmed by a clinical event committee. Patients with IE had a higher frequency of positive blood cultures (70.2% vs. 36.9%, p < 0.0001), embolic diseases (36.2% vs. 10.8%, p < 0.0001), heart murmurs (27.7% vs. 11.7%, p = 0.01), and intensive care therapy (74.5% vs. 58.4%, p = 0.04). In receiver operating characteristics, the combination of modified Duke criteria without transesophageal echocardiography led to an area under the curve of 0.783 (0.715-0.851). The predictive value was only marginally improved by the addition of heart murmur and intensive care therapy (0.794 [0.724-0.863]). In contrast, transesophageal echocardiography alone achieved an area under the curve of 0.956 (0.937-0.977) and was further improved when adding modified Duke criteria, heart murmur, and intensive care therapy (0.999 [0.998-1.000]). CONCLUSION Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography. TRIAL REGISTRATION NCT03365193.
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Ren Z, Zhang J, Chen H, Mo X, Cai S, Peng J. Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018. Cardiovasc Ultrasound 2021; 19:2. [PMID: 33388076 PMCID: PMC7778797 DOI: 10.1186/s12947-020-00229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results. METHODS Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018. RESULTS A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of "definite cases" before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (< 10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors. CONCLUSIONS Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.
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Affiliation(s)
- Zuning Ren
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Zhang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xichao Mo
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Patel MJ, Elzweig J. Non-bacterial thrombotic endocarditis: a rare presentation and literature review. BMJ Case Rep 2020; 13:13/12/e238585. [PMID: 33318278 PMCID: PMC7737039 DOI: 10.1136/bcr-2020-238585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 66-year-old woman with a remote history of breast cancer and prior tobacco use presented to the hospital with chest pain. She was found to have an elevated troponin consistent with a diagnosis of a non-ST segment elevation myocardial infarction (NSTEMI). A left heart catheterisation revealed non-obstructive coronary disease, and subsequent transthoracic and transoesophageal echocardiograms demonstrated vegetations on both the mitral and aortic valves. Multiple blood cultures showed no growth raising suspicion for non-bacterial thrombotic endocarditis (NBTE). A CT of the chest, abdomen and pelvis was obtained that was consistent with metastatic pancreatic cancer. Her hospital course was complicated by recurrent embolic strokes leading to a rapid clinical deterioration. As a result, she was transitioned to comfort measures and passed away shortly thereafter. To our knowledge, this is the first reported case of an NSTEMI as the initial presentation of NBTE due to underlying malignancy.
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Affiliation(s)
- Maulin J Patel
- Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Joel Elzweig
- Medicine Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
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Mihos CG, Nappi F. A narrative review of echocardiography in infective endocarditis of the right heart. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1622. [PMID: 33437821 PMCID: PMC7791248 DOI: 10.21037/atm-20-5198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Infective endocarditis (IE) is characterized by bacterial or fungal masses that form in the cardiac chambers and valves, and in severe cases invade the endocardium or intra-cardiac vessels. Right-sided IE accounts for 5% to 10% of cases, with a low mortality cited at 6%. A history of intravenous drug abuse (IVDU) is present in 90% of isolated right-sided IE cases, with normal intra-cardiac anatomy prior to infection in approximately 80%. Nevertheless, up to 50% of patients require early surgical intervention which is associated with significant peri-operative morbidity. Echocardiography is the gold standard for diagnosis with a sensitivity of 80% for the transthoracic modality and 95% for transesophageal studies; it provides important clinical information regarding the severity of infection and development of secondary complications. This includes identification of active infective vegetations, healed IE, prosthetic valve IE, and abscess formation and rupture. Prompt clinical, microbiologic, and imaging assessment of patients with suspected left or right-sided IE is of paramount importance and is reflected in the modified Duke criteria, the well-validated algorithm for accurate and timely diagnosis of IE. Data suggests the criteria sensitivity may be decreased in right-sided IE only, and thus, care must be taken to perform skilled and detailed echocardiographic assessments of the right heart in suspected cases. Herein we provide a review of IE of the right heart, with a focus on pathophysiology and its echocardiographic presentation and characteristics.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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Mahmoud K, Hammouda T, Kandil H, Mashaal M. Prevalence and predictors of aortic root abscess among patients with left-sided infective endocarditis: a cross-sectional comparative study. Egypt Heart J 2020; 72:62. [PMID: 32990862 PMCID: PMC7524951 DOI: 10.1186/s43044-020-00098-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aortic root abscess (ARA) is a major complication of infective endocarditis that is associated with increased morbidity and mortality. Limited data are present about patient characteristics and outcomes in this lethal disease. We aimed to study the clinical and echocardiographic characteristics of patients with ARA compared to patients with left-sided infective endocarditis without ARA. We included patients with a definite diagnosis of left-sided infective endocarditis according to modified Duke's criteria. The patients were classified into two groups according to the presence of ARA (ARA and NO-ARA groups). All the patients were studied regarding their demographic data, clinical characteristics, laboratory and imaging data, and complications. RESULTS We included 285 patients with left-sided infective endocarditis. The incidence of ARA was 21.4% (61 patients). Underlying heart disease, mechanical prosthesis, bicuspid aortic valve, and prior IE were significantly higher in ARA. The level of CRP was higher in ARA (p = 0.03). ARA group showed more aortic valve vegetations (73.8% vs. 37.1%, p < 0.001), more aortic paravalvular leakage (26.7% vs. 4.5%, p < 0.001), and less mitral valve vegetations (21.3% vs. 68.8%, p < 0.001). Logistic regression analysis showed that the odds of ARA increased in the following conditions: aortic paravalvular leak (OR 3.9, 95% CI 1.2-13, p = 0.03), mechanical prosthesis (OR 3.6, 95% CI 1.5-8.7, p = 0.005), aortic valve vegetations (OR 3.0, 95% CI 1.2-8.0, p = 0.02), and undetected organism (OR 2.3, 95% CI 1.1-4.6, p = 0.02), while the odds of ARA decreased with mitral valve vegetations (OR 0.2, 95% CI 0.08-0.5, p = 0.001). We did not find a difference between both groups regarding the incidence of major complications, including in-hospital mortality. CONCLUSION In our study, ARA occurred in one fifth of patients with left-sided IE. Patients with mechanical prosthesis, aortic paravalvular leakage, aortic vegetations, and undetected organisms had higher odds of ARA, while patients with mitral vegetations had lower odds of ARA.
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Ramanathan A, Witten JC, Gordon SM, Griffin BP, Pettersson GB, Shrestha NK. Factors associated with local invasion in infective endocarditis: a nested case-control study. Clin Microbiol Infect 2020; 27:1011-1014. [PMID: 32919070 DOI: 10.1016/j.cmi.2020.09.003] [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: 07/10/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A substantial proportion of infective endocarditis (IE) cases are complicated by local invasion. The purpose of this study was to identify patient and disease characteristics associated with local invasion in surgically treated IE patients. METHODS This was a nested case-control study. All episodes of IE for patients admitted to Cleveland Clinic from 1 January 2013 to 30 June 2016 were identified from the Cleveland Clinic IE Registry. Patients ≥18 years of age who underwent surgery for IE were included. Among these, cases were those with local invasion, controls were those without. Local invasion, defined as periannular extension, paravalvular abscess, intracardiac fistula or pseudoaneurysm, was ascertained from the surgical operative note. Associations of selected factors with local invasion were examined in a multivariable logistic regression model. RESULTS Among 511 patients who met inclusion criteria, 215 had local invasion. Mean age was 56 years; 369 were male. Overall 345 (68%) had aortic valve, 228 (45%) mitral valve, and 66 (13%) tricuspid or pulmonic valve involvement. Aortic valve involvement (OR 6.23, 95% CI 3.55-11.44), bioprosthetic valve (OR 3.88, 95% CI 2.36-6.44), significant paravalvular leak (OR 3.80, 95% CI 1.60-9.89), new atrioventricular nodal block (OR 3.77, 95% CI 1.87-7.90), infection with streptococci other than viridans group streptococci (OR 7.54, 95% CI 2.42-24.87) and presence of central nervous system emboli (OR 1.85, 95% CI 1.13-3.04) were associated with local invasion. DISCUSSION Intracardiac and microorganism factors, but not comorbid conditions, are associated with local invasion in IE.
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Affiliation(s)
- Abarna Ramanathan
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - James C Witten
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Gosta B Pettersson
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
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Mahmood M, Abu Saleh O. The Role of 18-F FDG PET/CT in Imaging of Endocarditis and Cardiac Device Infections. Semin Nucl Med 2020; 50:319-330. [DOI: 10.1053/j.semnuclmed.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Isaza N, Shrestha NK, Gordon S, Pettersson GB, Unai S, Vega Brizneda M, Witten JC, Griffin BP, Xu B. Contemporary Outcomes of Pulmonary Valve Endocarditis: A 16-Year Single Centre Experience. Heart Lung Circ 2020; 29:1799-1807. [PMID: 32616369 DOI: 10.1016/j.hlc.2020.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Limited data exist regarding the clinical characteristics and contemporary outcomes of patients with pulmonary valve (PoV) infective endocarditis (IE). METHODS This is a retrospective cohort study of patients with a confirmed diagnosis of IE affecting the PoV at our centre between January 2002 and October 2018. Electronic medical records were reviewed to gather the clinical and echocardiographic variables. The population was subdivided according to risk factor profiles: group 1: miscellaneous risk factors; group 2: patients with congenital heart disease (CHD); and group 3: patients who inject drugs (PWID). The primary outcome was all-cause mortality. RESULTS Out of 2,124 cases of IE during the study period, 24 (1.1%) patients had PoV IE. The majority of cases of PoV IE occurred in patients with prosthetic valves (54.2%). Coagulase-negative Staphylococci species were the most common micro-organisms. Seventy-five per cent (75%) of the patients required surgical management. The median follow-up was 2.8 years (interquartile range: 0.2-5.3 years). Patients with miscellaneous risk factors were older (p<0.01), and had higher rates of hypertension (p=0.01) and hyperlipidaemia (p=0.04). There was a statistically significant difference in survival between the groups (p=0.03), mainly driven by better outcomes of patients with CHD, compared to those with miscellaneous risk factors. CONCLUSIONS In a contemporary 16-year series, a high proportion of patients with PoV IE required surgical management. Patients with PoV IE and CHD had better survival, compared to patients with miscellaneous risk factors at a median follow-up of 2.8 years.
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Affiliation(s)
- Nicolas Isaza
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Maria Vega Brizneda
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James C Witten
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
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Hubers SA, DeSimone DC, Gersh BJ, Anavekar NS. Infective Endocarditis: A Contemporary Review. Mayo Clin Proc 2020; 95:982-997. [PMID: 32299668 DOI: 10.1016/j.mayocp.2019.12.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
Infective endocarditis (IE), initially described more than 350 years ago, involves infection of the endocardial surface of the heart. The clinical manifestations of IE can involve every organ system, and the cardiac manifestations can include valvular vegetation, abscess, periannular extension of infection, and myopericarditis. Echocardiography is crucial in the diagnosis of IE, but alternative imaging modalities are playing an increasing role in the diagnosis and management of IE. Multidisciplinary care is imperative to the management of IE, often requiring the expertise of cardiologists, cardiothoracic surgeons, infectious diseases specialists, radiologists, and neurologists. We performed a literature search of the PubMed database from January 1st, 2000, to September 30th, 2019, using the terms infective endocarditis, diagnosis, and management to find the most pertinent and highest-quality evidence. This review summarizes key aspects of IE, with a focus on emerging advances in diagnosis. We also highlight growing patient populations at risk for IE, including patients with intracardiac devices and congenital heart disease.
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Affiliation(s)
- Scott A Hubers
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN.
| | - Daniel C DeSimone
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
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Guiomar N, Vaz-da-Silva M, Mbala D, Sousa-Pinto B, Monteiro JP, Ponce P, Carneiro F, M Guerra, Neves F, Ferraz R, Rijo D, Teixeira M, Vouga L, Braga P. Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. Rev Port Cardiol 2020; 39:137-149. [PMID: 32340853 DOI: 10.1016/j.repc.2019.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/10/2019] [Accepted: 08/01/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.
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Affiliation(s)
- Neusa Guiomar
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - M Vaz-da-Silva
- Faculdade de Medicina da Universidade do Porto e Serviço de Cardiologia do Centro Hospitalar S. João, Porto, Portugal
| | - D Mbala
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - B Sousa-Pinto
- Cintesis, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - J P Monteiro
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Ponce
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Carneiro
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Guerra
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Neves
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Ferraz
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - D Rijo
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Teixeira
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - L Vouga
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Braga
- Serviço de Cardiologia do Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Kadam M, Birns J, Bhalla A. The management of infective endocarditis complicated by stroke. Int J Clin Pract 2020; 74:e13469. [PMID: 31877574 DOI: 10.1111/ijcp.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mustafa Kadam
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Jonathan Birns
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Ajay Bhalla
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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36
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Guiomar N, Vaz-da-Silva M, Mbala D, Sousa-Pinto B, Monteiro J, Ponce P, Carneiro F, Guerra M, Neves F, Ferraz R, Rijo D, Teixeira M, Vouga L, Braga P. Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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D’Angelo M, Boretti I, Quattrocchi S, Alongi G, Rifici C, Corallo F, Magazù A, Milardi D, Cannavà G, Bramanti P, Duca A. Lethal infective endocarditis due to Streptococcus agalactiae in a man with a history of alcohol abuse: A case report. Medicine (Baltimore) 2019; 98:e18270. [PMID: 31860973 PMCID: PMC6940177 DOI: 10.1097/md.0000000000018270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONAL Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium. PATIENT CONCERNS A 53-years-old man with a history of alcohol abuse was admitted in hospital for fever, paroxysmal atrial fibrillation cardioverted by Amiodarone and pulmonary infection. DIAGNOSIS A case of recurrent severe endocarditis, with neurological complications both ischemic and hemorrhagic and heart failure caused by Streptococcus agalactiae in healthy man we reported. INTERVENTIONS Surgery was performed 2 weeks after admission. OUTCOMES The onset of intracranial hemorrhage delayed second cardiac surgery and the patient died because of end-stage heart failure. CONCLUSIONS Infective endocarditis caused by S. agalactiae is very rare, particularly in patients without underlying structural heart disease. This study showed that IE due to S. Agalactiae is a disease with high mortality when associated with neurological complication, heart failure but especially when it is recurrent and hits valve prosthesis.
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Affiliation(s)
- Myriam D’Angelo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Ilaria Boretti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Salvina Quattrocchi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Giovanni Alongi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Carmela Rifici
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Francesco Corallo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Angela Magazù
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Demetrio Milardi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Italy
| | - Gaetano Cannavà
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Placido Bramanti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
| | - Antonio Duca
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino Pulejo”, Messina
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Erba PA, Pizzi MN, Roque A, Salaun E, Lancellotti P, Tornos P, Habib G. Multimodality Imaging in Infective Endocarditis: An Imaging Team Within the Endocarditis Team. Circulation 2019; 140:1753-1765. [PMID: 31738598 DOI: 10.1161/circulationaha.119.040228] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Infective endocarditis (IE) is a complex disease with cardiac involvement and multiorgan complications. Its prognosis depends on prompt diagnosis that leads to an aggressive therapeutic management combining antibiotic therapy and early cardiac surgery when indicated. However, IE diagnosis always poses a challenge, and echocardiography remains diagnostically imperfect in cases of prosthetic valve IE or cardiac implantable electronic device infection. In recent years, other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) have experienced significant technical improvements, and their application to the detection of cardiac and extracardiac IE-related lesions seems to be a strategic way forward in the management of patients with suspected IE. However, the scientific evidence in the literature remains limited; current guidelines address the use of the multimodality imaging in the field of IE with caution; the incremental value of each technique and their combinations is debated; and their use varies across countries. Despite these limitations, healthcare providers and surgeons should be aware of the possibilities offered by the multimodal imaging approach when appropriate. Here, we emphasize the value of a multidisciplinary heart valve team, the endocarditis team, underlining the importance of cardiac and extracardiac imaging experts in playing a key role in informing the diagnosis and management of patients with IE. Illustrative cases, critical appraisal of contemporary data, and conceptual and practical suggestions for clinicians that may help to improve the prognosis of patients with IE are provided in this review article.
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Affiliation(s)
- Paola A Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Italy (P.A.E.).,University of Groningen, University Medical Center Groningen, Medical Imaging Center, The Netherlands (P.A.E.)
| | - Maria N Pizzi
- Departments of Cardiology (M.N.P.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain (M.N.P., A.R., P.T.)
| | - Albert Roque
- Radiology (A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain (M.N.P., A.R., P.T.)
| | - Erwan Salaun
- APHM, La Timone Hospital, Cardiology Department, Marseille, France (E.S., G.H.)
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Belgium (P.L.).,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy (P.L.)
| | - Pilar Tornos
- Department of Cardiology, Hospital Quirónsalud, Barcelona, Spain (P.T.)
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Marseille, France (E.S., G.H.).,Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, France (G.H.)
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Amuchastegui T, Hur DJ, Lynn Fillipon NM, Eder MD, Bonomo JA, Kim Y, McNamara RL, Malinis M, Sugeng L. An assessment of transesophageal echocardiography studies rated as rarely appropriate tests for infective endocarditis at an academic medical center. Echocardiography 2019; 36:2070-2077. [PMID: 31705577 DOI: 10.1111/echo.14525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/10/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Endocardial involvement documented by echocardiography is a major criterion of the modified Duke criteria (MDC) for infective endocarditis (IE). Though transesophageal echocardiography (TEE) is sensitive in the diagnosis of IE, it can be inappropriately used. METHODS This retrospective study included all patients who underwent TEE due to bacteremia, fever, and/or endocarditis in a single, tertiary academic medical center in 2013. Data collected from electronic medical charts were as follows: demographics, history, physical examination, blood cultures, and transthoracic (TTE) and TEE findings. Cases were categorized based on appropriate use criteria (AUC) and MDC. An infectious disease (ID) specialist reviewed cases with rarely appropriate TEE use. RESULTS In the 194 patients included, 147 (75.8%) were rated as appropriate, 36 (18.6%) rarely appropriate, and 11 (5.6%) uncertain. Of the 36 with rarely appropriate TEEs, using MDC 31 (86%) were rejected and 5 (14%) were possible for IE. Retrospective chart review by an ID specialist determined that 10 of these patients warranted TEE due to compelling issues, including immunosuppression or complicated infection. CONCLUSIONS In this retrospective cohort, almost one fifth of cases were rated as rarely appropriate. However, a review of these cases showed that TEE was often pursued when the clinical situation involved immunosuppression or complex infectious process. There remains room for improvement to our screening process for TEE and a need to implement a nuanced educational plan to better precisely identify appropriate cases for TEE usage.
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Affiliation(s)
- Tomas Amuchastegui
- Internal Medicine Service, Hospital Privado Universitario de Córdoba and Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.,Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - David J Hur
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Nicole M Lynn Fillipon
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiology, Worcester Medical Center, Worcester, Massachusetts
| | - Maxwell D Eder
- Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Jason A Bonomo
- Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Maricar Malinis
- Section of Infectious Diseases, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
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40
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Kroegh G, Jawad K, Davierwala P, Borger M, Misfeld M. Diagnostic tools in surgically treated patients with infective valve endocarditis. Ann Cardiothorac Surg 2019; 8:654-660. [PMID: 31832355 DOI: 10.21037/acs.2019.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Infective valve endocarditis (IE) is associated with significant mortality and complication rates. The diagnosis impacts not only the prognosis but also the management of the disease. The aim of this article is to show the findings obtained from the implementation of our most important diagnostic tools and discuss our standard diagnostic process for patients with IE who underwent surgical treatment between 1994 and 2017. Methods Between December 1994 and January 2017 a total of 2,458 patients with IE underwent surgery at our institution. We analyzed clinical, microbiological, echocardiographic, and multi slice computer tomographic (MSCT) features in this group. Results The most often isolated involved valve was the aortic valve (59%). Prosthetic valve endocarditis (PVE) was present in almost one third of all cases. The most common valve failures were mitral valve insufficiency (MI) and aortic valve insufficiency (AI) (65% and 57% respectively). Almost one half of the aortic insufficiencies were severe. 63% of all vegetations assessed by echocardiography were larger than 1 cm. We detected a septic embolism in 44% of patients and the most common target organ was the spleen (25%). The most common isolated pathogen was Staphylococcus aureus (26%) and affected patients had a significant correlation with in-hospital mortality (P=0.004). Conclusions Echocardiography offers valuable information and is the most important diagnostic method in patients with IE. Preoperative MSCT contributes to the entire perioperative decision-making process. Microbiological diagnosis is mandatory in choosing and adjusting antibiotic therapy and also has prognostic value.
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Affiliation(s)
- Guenther Kroegh
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Piroze Davierwala
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
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41
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Braiteh N, Ebeid K, Yarkoni A, Beckles DL, Fenlon C. A Large Mitral Valve Vegetation Not Visualized on Transthoracic Echocardiography: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1422-1426. [PMID: 31558692 PMCID: PMC6777387 DOI: 10.12659/ajcr.918592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Male, 41 Final Diagnosis: Mitral valve endocarditis Symptoms: ltered mental status • fatigue • fever • myalgia Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Nabil Braiteh
- Department of Cardiology, United Health Services Hospitals (Heart and Vascular Institute), Wilson Medical Center, Johnson City, NY, USA
| | - Kareem Ebeid
- Department of Internal Medicine, United Health Services Hospitals (Heart and Vascular Institute), Wilson Medical Center, Johnson City, NY, USA
| | - Alon Yarkoni
- Department of Cardiology, United Health Services Hospitals (Heart and Vascular Institute), Wilson Medical Center, Johnson City, NY, USA
| | - Daniel L Beckles
- Department of Cardiothoracic Surgery, United Health Services Hospitals (Heart and Vascular Institute), Wilson Medical Center, Johnson City, NY, USA
| | - Christine Fenlon
- Department of Infectious Disease and Internal Medicine, United Health Services Hospitals (Heart and Vascular Institute), Wilson Medical Center, Johnson City, NY, USA
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42
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Lin CJ, Chua S, Chung SY, Hang CL, Tsai TH. Diabetes Mellitus: An Independent Risk Factor of In-Hospital Mortality in Patients with Infective Endocarditis in a New Era of Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122248. [PMID: 31242695 PMCID: PMC6617149 DOI: 10.3390/ijerph16122248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Abstract
Infective endocarditis (IE) is a severe disease with a hospital mortality rate of 17–25%. Early identification of IE patients with high risk of mortality may improve their clinical outcomes. Patients with diabetes mellitus (DM) who develop infective diseases are associated with worse outcomes. This study aimed to define the impact of DM on long-term mortality in IE patients. A total of 412 patients with definite IE from February 1999 to June 2012 were enrolled in this observational study and divided into 2 groups: group 1, patients with DM (n = 72) and group 2, patients without DM (n = 340). The overall in-hospital mortality rate for both groups combined was 20.2% and was higher in group 1 than in group 2 (41.7% vs. 16.5%, p < 0.01). Compared to patients without DM, patients with DM were older and associated with higher incidence of chronic diseases, less drug abuse, higher creatinine levels, and increased risk of Staphylococcus aureus infection (all p < 0.05). Moreover, they were more likely to have atypical clinical presentation and were associated with longer IE diagnosis time (all p < 0.05). In multivariable analysis, DM is an independent and significant predictor of mortality. The prognosis of IE patients with DM is still poor. Early identification and more aggressive treatment may be considered in IE patients with DM.
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Affiliation(s)
- Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
- Chang Gung University College of Medicine, Kaohsiung, Taiwan, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
- Chang Gung University College of Medicine, Kaohsiung, Taiwan, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
- Chang Gung University College of Medicine, Kaohsiung, Taiwan, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
- Chang Gung University College of Medicine, Kaohsiung, Taiwan, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
- Chang Gung University College of Medicine, Kaohsiung, Taiwan, No.123, DAPI Rd. Niaosong District, Kaohsiung City 83301, Taiwan.
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43
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Østergaard L, Andersson NW, Kristensen SL, Dahl A, Bundgaard H, Iversen K, Eske-Bruun N, Gislason G, Torp-Pedersen C, Valeur N, Køber L, Fosbøl EL. Risk of stroke subsequent to infective endocarditis: A nationwide study. Am Heart J 2019; 212:144-151. [PMID: 31004917 DOI: 10.1016/j.ahj.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the study was to investigate the associated risk of stroke after discharge of infective endocarditis (IE) in patients with stroke during IE admission compared with patients without stroke during IE admission. METHODS Using Danish nationwide registries, we identified nonsurgically treated patients with IE discharged alive in the period from 1996 to 2016. The study population was grouped into (1) patients with stroke during IE admission and (2) patients without stroke during IE admission. Multivariable adjusted Cox proportional-hazard analysis was used to compare the associated risk of stroke between groups. RESULTS We identified 4,284 patients with IE, of whom 239 (5.6%) had a stroke during IE admission. We identified differentials in the associated risk of stroke during follow-up between groups (P = .006 for interaction with time). The associated risk of stroke was higher in patients with stroke during IE admission with a 1-year follow-up, HR = 3.21 (95% CI 1.66-6.20), compared with patients without stroke during IE admission. From 1 to 5 years of follow-up, we identified no difference in the associated risk of stroke between groups, HR = 0.91 (95% CI 0.33-2.50). CONCLUSIONS Patients with nonsurgically treated IE with a stroke during IE admission were at significant higher associated risk of subsequent stroke within the first year of follow-up as compared with patients without a stroke during IE admission. This risk difference was not evident beyond 1 year of discharge. These findings underline the need for identification of causes and mechanisms of recurrent strokes after IE to develop preventive means.
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Affiliation(s)
| | | | | | - Anders Dahl
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark; Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Niels Eske-Bruun
- Clinical Institute, University of Aalborg, Aalborg, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Clinical Institute, Copenhagen University, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology and Department of Cardiology, University of Aalborg, Aalborg, Denmark; Clinical Institute, University of Aalborg, Aalborg, Denmark
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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Kiani S, Sabayon D, Lloyd MS, Hoskins MH, El‐Chami MF, Westerman S, Vadlamudi R, Keeling B, Lattouf OM, Merchant FM. Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1032-1037. [DOI: 10.1111/pace.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Soroosh Kiani
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Dean Sabayon
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Michael S. Lloyd
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Michael H. Hoskins
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Mikhael F. El‐Chami
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Stacy Westerman
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Ratna Vadlamudi
- Department of AnesthesiologyEmory University School of Medicine Atlanta Georgia
| | - Brent Keeling
- Division of Cardiothoracic Surgery, Department of SurgeryEmory University School of Medicine Atlanta Georgia
| | - Omar M. Lattouf
- Division of Cardiothoracic Surgery, Department of SurgeryEmory University School of Medicine Atlanta Georgia
| | - Faisal M. Merchant
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
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45
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Delahaye F, De Gevigney G. Diagnostic de l’endocardite infectieuse. Presse Med 2019; 48:522-531. [DOI: 10.1016/j.lpm.2019.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/21/2019] [Indexed: 11/16/2022] Open
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46
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El Barzouhi A, Tanis W, van Gelder RE, Vriend JWJ. The pivotal role of cardiac computed tomography angiogram and 18F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:yty165. [PMID: 31020241 PMCID: PMC6439376 DOI: 10.1093/ehjcr/yty165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
Background Infective endocarditis (IE) poses many clinical and diagnostic challenges. Echocardiography is regarded as the imaging modality of choice for the diagnosis of IE, and plays a key role in both the diagnosis and management of endocarditis. We report on a case in which one could have overlooked an endocarditis of a pulmonary homograft if one had relied on echocardiography alone. Case summary A 38-year-old man presented with intermittent fever and fatigue for 1 month. He had undergone a Ross procedure for a bicuspid aortic valve stenosis at the age of 17 years. At the age of 36 years a valve-sparing aortic root replacement was performed because of aortic root dilatation. Besides a systolic murmur 3/6 noted at the left sternal border, physical examination was normal. Multiple blood cultures grew Streptococcus mitis. Both transthoracic and transoesophageal echocardiogram could not detect any signs of endocarditis. As endocarditis can be overlooked due to reverberations and acoustic shadowing, we performed 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) and cardiac computed tomography angiogram (cardiac CTA). Both imaging modalities showed large vegetations attached to the pulmonary homograft. Discussion Endocarditis poses diagnostic challenges. While echocardiography is the cornerstone of imaging, one may overlook a pulmonary homograft endocarditis due to reverberations and acoustic shadowing. Therefore, if clinical suspicion of endocarditis is strong, one should consider additional imaging by means of cardiac CTA and/or 18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging to assess valves in pulmonary position, especially in those whom have had prior surgical intervention at this location.
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Affiliation(s)
- Abdelilah El Barzouhi
- Department of Cardiology, Haga Teaching Hospital, Postbus 40551, LN The Hague, The Netherlands
| | - Wilco Tanis
- Department of Cardiology, Haga Teaching Hospital, Postbus 40551, LN The Hague, The Netherlands
| | - Rogier E van Gelder
- Department of Radiology, Haga Teaching Hospital, Postbus 40551, LN The Hague, The Netherlands
| | - Joris W J Vriend
- Department of Cardiology, Haga Teaching Hospital, Postbus 40551, LN The Hague, The Netherlands
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Abstract
PURPOSE OF REVIEW The purpose of this article is to provide a brief overview of the medical and surgical management of infective endocarditis secondary to IDU, with a focus on the underlying substance use disorder. RECENT FINDINGS Patients with infective endocarditis secondary to IDU are often young with unique comorbidities including mental illness, chronic hepatitis C, HIV infection, which are often compounded by limited social and familial supports. The focus of management has been treatment of endocarditis using IV antibiotics alongside surgery. Surgical outcomes compare favorably with those of infective endocarditis in the general population but long-term outcomes of IDUs are significantly worse. This is primarily due to the high rate of recidivism of drug use and the risk of prosthetic valve infective endocarditis. Contemporary management of addiction utilizes an integrative approach, combining both pharmacologic and nonpharmacologic strategies while remaining patient-centered. Given the complexity of care required, we advocate for a multidisciplinary team-based approach including psychiatry, infectious disease, cardiology, cardiac surgery and social services. SUMMARY Infective endocarditis secondary to IDU remains a medical and surgical challenge with dismal outcomes. Here we offer practical suggestions on the multidisciplinary management of this challenging and high-risk patient cohort.
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48
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Stöbe S, Metze M, Spies C, Hagendorff A. [Transesophageal echocardiography in emergency and intensive care medicine : Indication and implementation]. Med Klin Intensivmed Notfmed 2019; 114:490-498. [PMID: 30830290 DOI: 10.1007/s00063-019-0549-8] [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: 01/31/2019] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
Transesophageal echocardiography (TEE) in emergency and intensive care medicine represents an additional semi-invasive method to confirm or rebut suspected diagnoses in critically ill patients. Three-dimensional (3D)-TEE investigations are established in the clinical workflow of emergency and intensive care units because 3D-TEE investigations permit a differentiation of artifacts due to oblique views by simultaneous documentation of sectional planes and en face views of characteristic cardiac structures. Thus, the level of diagnostic validity can be significantly increased by 3D-TEE investigation. The main indications of TEE investigation in emergency medicine are hemodynamic instability due to myocardial, pericardial or valvular heart diseases as well as suspected endocarditis and aortic dissection.
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Affiliation(s)
- S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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49
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Pérez-García CN, Olmos C, Islas F, Marcos-Alberca P, Pozo E, Ferrera C, García-Arribas D, Pérez de Isla L, Vilacosta I. Morphological characterization of vegetation by real-time three-dimensional transesophageal echocardiography in infective endocarditis: Prognostic impact. Echocardiography 2019; 36:742-751. [PMID: 30805998 DOI: 10.1111/echo.14293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/24/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Vegetation size is a prognostic predictor in infective endocarditis (IE) and guides surgical management. The aim of this study was to evaluate the accuracy of real-time 3-dimensional transesophageal echocardiography (RT3DTEE) compared to 2DTEE in the diagnosis and characterization of vegetation, as well as its potential clinical impact. METHODS Two hundred and three consecutive patients with IE were recruited (2009-2016) and retrospectively analyzed. Vegetation diameters and area from 68 patients were measured by 2DTEE and RT3DTEE at admission. The association between size and systemic embolisms was evaluated with logistic regression models. Differences in the discriminative power for the best dimensions' cutoff points were assessed by comparing the area under the ROC curves (AUC). RESULTS Vegetation size and area were larger by RT3DTEE (P < 0.001) than by 2DTEE, and RT3DTEE was especially relevant in the characterization of nonfiliform vegetation, Morphology was strongly associated with friability, being sessile vegetation less likely to embolize, compared to filiform and raceme-shaped ones (15.4% vs 46% vs 50%). Major diameter by RT3DTEE had better embolic predictive performance than 2DTEE (AUC 0.76 [0.57-0.89] vs 0.71 [0.53-0.86]; P = 0.611). The best cutoff points associated with embolic events during the infection were 17 mm for RT3DTEE and 15 mm for 2DTEE. Based exclusively on vegetation size, the proportion of patients meeting a surgical indication according to current guidelines is higher using RT3DTEE. CONCLUSIONS RT3DTEE allows a better characterization of IE vegetation than 2DTEE, what may have a clinical impact on surgical management and also prognostic due to a more accurate prediction of embolic risk.
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Affiliation(s)
- Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Pedro Marcos-Alberca
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Eduardo Pozo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Leopoldo Pérez de Isla
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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50
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Tamura Y, Nomura A, Yoshida S, Tada H, Sakata K, Iino K, Furusho H, Takamura M, Takemura H, Yamagishi M, Kawashiri MA. Quick sepsis-related organ failure assessment score as a possible predictor for in-hospital adverse events in infective endocarditis. Acute Med Surg 2019; 6:138-144. [PMID: 30976439 PMCID: PMC6442521 DOI: 10.1002/ams2.393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/12/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Infective endocarditis (IE) can be life‐threatening because of various associated adverse events. The quick Sepsis‐related Organ Failure Assessment (qSOFA) score is a straightforward useful method for predicting in‐hospital mortality in patients with suspected infections. However, few data exist regarding the clinical impact of the qSOFA score on predicting adverse events in IE during hospitalization. We studied the usefulness of qSOFA score for predicting in‐hospital adverse events in patients with IE. Methods We retrospectively analyzed 104 consecutive patients diagnosed with IE on the basis of modified Duke criteria. We defined in‐hospital adverse events as occurrence of any of the following events during hospitalization: death, embolism, hemorrhage, or abscess formation. The high qSOFA group was defined as those with a qSOFA score ≥2. We used Cox regression analysis to estimate the hazard ratio for high qSOFA score on in‐hospital adverse events adjusted for age, sex, and Staphylococcus aureus infection. Results We analyzed 83 patients (57 men, mean age 61 ± 18 years) from the total cohort of 104 patients enrolled. Among these, 12 (14.5%) had high qSOFA scores. The high qSOFA group had higher in‐hospital mortality compared to the low qSOFA group (50.0% vs. 4.2%, P < 0.01). In the Cox proportional hazards model, high qSOFA was significantly associated with in‐hospital adverse events (adjusted hazard ratio, 2.29; confidence interval, 1.02–5.12; P = 0.044). Conclusion These results showed that high qSOFA score was significantly associated with in‐hospital adverse events in IE patients, although further prospective study is necessary to confirm our results.
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Affiliation(s)
- Yudai Tamura
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Akihiro Nomura
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan.,Innovative Clinical Research Center Kanazawa University (iCREK) Kanazawa Japan
| | - Shohei Yoshida
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Hayato Tada
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Kenji Sakata
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Kenji Iino
- Department of Thoracic, Cardiovascular and General Surgery Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Hiroshi Furusho
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan
| | | | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Masakazu Yamagishi
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
| | - Masa-Aki Kawashiri
- Division of Cardiology Kanazawa University Hospital Kanazawa Japan.,Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medicine Kanazawa Japan
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