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Quintero-Martinez JA, Hindy JR, Michelena HI, DeSimone DC, Baddour LM. Infective Endocarditis in Patients With Bicuspid Aortic Valves: Unique Clinical and Microbiologic Features. Heart Lung Circ 2024:S1443-9506(24)00200-2. [PMID: 39153949 DOI: 10.1016/j.hlc.2024.02.023] [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: 12/22/2022] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE Patients with bicuspid aortic valves (BAV) are at increased risk of infective endocarditis (IE). Information of the clinical presentation and the microbiology of BAV-associated IE, however, is limited. Therefore, our study aimed to characterise the clinical features native valve endocarditis (NVE) in the setting of BAV and compared them to patients with prosthetic valve endocarditis (PVE) following BAV replacement. METHODS Adult patients with BAV or history of BAV with aortic valve replacement (AVR) and a definite or possible IE diagnosis within the Mayo Clinic Enterprise (USA) from January 2008 to December 2021, were included. BAV was confirmed by trans-oesophageal echocardiography. IE was defined according to the modified Duke criteria and only an initial episode was included. Statistical analyses were performed to compare clinical characteristics, microbiology, and IE complications. RESULTS Overall, 161 patients with BAV and IE (NVE [n=60], 37.3%) and PVE [n=101, 62.7%) were included. Mean age±SD was 56.5±16.1 years, and 139 (86.3%) patients were males. PVE patients were older (p<0.01) and had a higher rate of hypertension (p<0.01), chronic heart failure (p<0.01), chronic kidney disease (p<0.01), and perivalvular abscess (p<0.01). BAV patients with NVE had a higher prevalence of isolated mitral valve IE (p<0.01), moderate to severe aortic valve regurgitation (p<0.01) and combined aortic with mitral valve IE (p<0.01). Streptococcus mitis was the most common pathogen in NVE (30.0%) while Staphylococcus aureus was the most common in PVE (15.8%). CONCLUSIONS Patients with BAV are at risk of both NVE and PVE. Each syndrome has unique clinical features, including microbiologic findings, that should be appreciated in IE diagnosis and management.
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Affiliation(s)
- Juan A Quintero-Martinez
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Joya-Rita Hindy
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA
| | - Hector I Michelena
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Al Hennawi H, Khan SI, Khan A, Sadiq U, Cho SH. Swiss Cheese Heart: A Tale of Multiple Valve Perforations. Methodist Debakey Cardiovasc J 2024; 20:18-22. [PMID: 38618611 PMCID: PMC11011950 DOI: 10.14797/mdcvj.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
Gerbode defect, an anomalous connection between the left ventricle and right atrium, is often congenital but can be acquired or iatrogenically formed. We present an exceedingly rare case of this defect associated with multiple valve perforation in an otherwise healthy patient with bicuspid aortic valve and endocarditis.
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Affiliation(s)
| | | | - Aamna Khan
- Jefferson Abington Hospital, Abington, Pennsylvania, US
| | - Usama Sadiq
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, US
| | - Sung-Hae Cho
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, US
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3
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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4
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Zolfaghari F, Peighambari MM, Kohansal E, Sadeghpour A, Moradnejad P, Shafii Z. Comparative analysis of infective endocarditis in hemodialysis versus non-hemodialysis patients in Iran: implications for clinical practice and future research. BMC Cardiovasc Disord 2024; 24:8. [PMID: 38166765 PMCID: PMC10763015 DOI: 10.1186/s12872-023-03675-0] [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] [Received: 10/09/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In hemodialysis (HD) patients, there is a larger frequency of mortality and morbidity associated with infective endocarditis (IE) as opposed to the general population. Despite the increased burden of IE in the HD population, optimal strategies for prevention and management still need to be clarified. Elucidating the distinguishing features and outcomes of IE in HD patients is crucial to guide clinical decision-making and improve prognosis in this high-risk group. However, the details of IE characteristics, specifically in HD patients in the Middle East, are limited. OBJECTIVE To compare the clinical characteristics and short-term outcomes of IE between HD and non-HD patients. METHODS A retrospective analysis was carried out on 139 patients with infective endocarditis who were referred to a tertiary cardiovascular center in Iran from 2006 to 2018. The participants were split into HD (n = 34) and non-HD (n = 105) groups. Data pertaining to demographic characteristics, comorbidities, microbiological findings, occurrence of complications, therapeutic interventions, and mortality rates during hospital stay were gathered. RESULTS Diabetes, hypertension, and congestive heart failure were observed more frequently in HD patients. HD patients were more likely than non-HD patients to have involvement of the right valve (41.2% vs. 20.9%), larger vegetation, and extracardiac emboli. In-hospital mortality was 41.2% for HD patients versus 14.3% for non-HD patients. Mortality remained high after valve surgery in HD patients (38.2% vs. 10.5% in non-HD). CONCLUSION HD patients exhibited a distinct clinical profile of IE with worse short-term outcomes, including higher mortality.
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Affiliation(s)
- Fereshteh Zolfaghari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran
| | - Mohammad Mehdi Peighambari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Tehran, Iran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran
| | | | - Pardis Moradnejad
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran
| | - Zahra Shafii
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran.
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You YJ, Ko SM. Computed Tomography and Magnetic Resonance Imaging Findings of Bicuspid Aortic Valve and Related Abnormalities of the Heart and Thoracic Aorta. Korean J Radiol 2023; 24:960-973. [PMID: 37724590 PMCID: PMC10550744 DOI: 10.3348/kjr.2023.0312] [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: 01/30/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
The bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation. Patients with BAV are at higher risk of other congenital cardiovascular malformations and valvular dysfunction, including aortic stenosis/regurgitation and infective endocarditis. BAV may also be related to aortic wall abnormalities such as aortic dilatation, aneurysm, and dissection. The morphology of the BAV varies with the presence and position of the raphe and is associated with the type of valvular dysfunction and aortopathy. Therefore, accurate diagnosis and effective treatment at an early stage are essential to prevent complications in patients with BAV. This pictorial essay highlights the characteristics of BAV and its related congenital cardiovascular malformations, valvular dysfunction, aortopathy, and other rare cardiac complications using multimodal imaging.
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Affiliation(s)
- You Jin You
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Martínez-Sellés M, Muñoz P. Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditis. J Clin Med 2023; 12:5705. [PMID: 37685770 PMCID: PMC10488693 DOI: 10.3390/jcm12175705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Infective endocarditis (IE) has experienced enormous changes in recent decades [...].
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Affiliation(s)
- Manuel Martínez-Sellés
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain;
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, 28001 Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain;
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), 28029 Madrid, Spain
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Pereira SC, Abrantes AL, António PS, Morais P, Sousa C, David C, Pinto FJ, Almeida AG, Caldeira D. Infective endocarditis risk in patients with bicuspid aortic valve: Systematic review and meta-analysis. IJC HEART & VASCULATURE 2023; 47:101249. [PMID: 37547264 PMCID: PMC10400861 DOI: 10.1016/j.ijcha.2023.101249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Background Antibiotic prophylaxis in bicuspid aortic valve patients is currently a matter of debate. Although it is no longer recommended by international guidelines, some studies indicate a high risk of infective endocarditis. We aim to evaluate the risk of native valve infective endocarditis in bicuspid aortic valve patients and compare to individuals with tricuspid aortic valve. Methods Study search of longitudinal studies regarding infective endocarditis incidence in bicuspid aortic valve patients (compared with tricuspid aortic valve/overall population) was conducted through OVID in the following electronic databases: MEDLINE, CENTRAL, EMBASE; from inception until October 2020. The outcomes of interest were the incidence rate and relative risk of infective endocarditis. The relative risk and incidence rate (number of cases for each 10 000 persons-year) with their 95 % confidence intervals (95 %CI) were estimated using a random effects model meta-analysis. The study protocol was registered at PROSPERO CRD42020218639. Results Eight cohort studies were selected, with a total of 5351 bicuspid aortic valve patients. During follow up, 184 bicuspid aortic valve patients presented infective endocarditis, with an incidence rate of 48.13 per 10,000 patients-year (95 %CI 22.24-74.02), and a 12-fold (RR: 12.03, 95 %CI 5.45-26.54) increased risk compared with general population, after adjusted estimates. Conclusions This systematic review and meta-analysis suggests that bicuspid aortic valve patients have a significant high risk of native valve infective endocarditis. Large prospective high-quality studies are required to estimate more accurately the incidence of infective endocarditis, the relative risk and the potential benefit of antibiotic prophylaxis.
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Affiliation(s)
- Sara Couto Pereira
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
| | - Ana Lobato Abrantes
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
| | | | - Pedro Morais
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
| | - Catarina Sousa
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
- Centro Cardiovascular da Universidade de Lisboa – CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cláudio David
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
| | - Fausto J. Pinto
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
- Centro Cardiovascular da Universidade de Lisboa – CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ana G. Almeida
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
- Centro Cardiovascular da Universidade de Lisboa – CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Daniel Caldeira
- Cardiology Department, Hospital Universitário de Santa Maria – CHULN, Portugal
- Centro Cardiovascular da Universidade de Lisboa – CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Quintero-Martinez JA, Hindy JR, Zein SE, Vikram HR, Bosch W, DeSimone DC, Baddour LM. Species designation of streptococci causing infective endocarditis in patients with mitral valve prolapse. Int J Infect Dis 2023; 131:71-74. [PMID: 36967036 DOI: 10.1016/j.ijid.2023.03.043] [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: 02/01/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVES Viridans group streptococci (VGS) have been previously linked to infective endocarditis (IE) in patients with mitral valve prolapse (MVP). The species identification of VGS is now available in clinical laboratories; however, it has not been examined in MVP IE. Therefore, we detailed the clinical profile, species designations, and antibiotic susceptibility of VGS isolates from patients with MVP IE. METHODS We retrospectively queried all adults with MVP and a definite or possible IE diagnosis seen at medical centers of the Mayo Clinic Enterprise from January 2009 to December 2021. Data, including clinical characteristics, comorbidities, microbiology, and outcomes, were extracted from electronic health records. VGS isolates from patients with MVP and IE were subclassified into mutans, salivarius, anginosus, sanguinis, and mitis groups. RESULTS A total of 38 patients with MVP with IE due to streptococcal species were included. Overall, median age was 62.4 years and 32% of patients were females. The most prevalent comorbidities were diabetes mellitus (26%), hypertension (21%), heart failure (16%), and malignancy (16%). A total of (37%) patients presented with an embolic event at the time of their IE diagnosis, 27 (66%) required valve surgery, and no patient died within the hospital stay. The Streptococcus mitis group was the predominant (n = 17, 45%) species designation; S. anginosus and S. sanguinis were identified in three (8%) each; S. mutans in two (5%); and S. salivarius in one (3%). Non-VGS streptococcal pathogens included S. agalactiae in three patients (8%), S. equi in two (5%), and S. dysgalactiae and S. bovis in one each (3%). VGS were identified in five (13%) patients, but species designation was not done. No penicillin resistance was identified among the isolates. CONCLUSION The S. mitis group was the predominant species in our investigation. Continued evaluation of VGS species should be considered to profile the IE risk based on species identification.
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Affiliation(s)
- Juan A Quintero-Martinez
- Division of Infectious Diseases, Department of Medicine; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, NY, USA.
| | | | - Said El Zein
- Division of Infectious Diseases, Department of Medicine
| | - Holenarasipur R Vikram
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, NY, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, NY, USA
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1303] [Impact Index Per Article: 1303.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Sunnaa M, Dhawan R, Tabachnick D, Attanasio S. Bacterial Culture-Negative Acute Infective Endocarditis With Vegetation in Native Bicuspid Aortic Valve. Cureus 2023; 15:e35101. [PMID: 36945268 PMCID: PMC10024923 DOI: 10.7759/cureus.35101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
A 51-year-old male with a past medical history of bicuspid aortic valve, hypertension, and anterior cerebral artery stroke of unclear etiology three months earlier, presented to the Emergency Department with progressive shortness of breath, hemoptysis, and night sweats. The patient's echocardiogram revealed a mobile mass greater than 1.0 cm in diameter on the bicuspid aortic valve, which was not present on the echocardiogram three months prior, during his stroke workup. Per modified Duke's criteria, this patient was found to have 'definite' infective endocarditis despite persistently negative blood cultures. The patient underwent urgent surgical aortic valve replacement and a ventricular septal defect was noted that was not seen on prior imaging. The patient was discharged on intravenous antibiotics and warfarin. The patient was able to return to his normal functional status weeks after surgery, and is continuing to exercise without limitation. This case provides an example of patients with bicuspid aortic valves having an increased propensity for developing infective endocarditis. While also highlighting the interesting intra-operative images and presentation of acute culture-negative endocarditis with vegetation, and the subsequent repair, treatment, and recovery.
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Affiliation(s)
- Michael Sunnaa
- Internal Medicine, Rush University Medical Center, Chicago, USA
| | - Ritika Dhawan
- Internal Medicine, Rush University Medical Center, Chicago, USA
| | - Deborah Tabachnick
- Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, USA
| | - Steve Attanasio
- Cardiovascular Medicine, Rush University Medical Center, Chicago, USA
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11
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van Melle JP, Roos-Hesselink JW, Bansal M, Kamp O, Meshaal M, Pudich J, Luksic VR, Rodriguez-Alvarez R, Sadeghpour A, Hanzevacki JS, Sow R, Timóteo AT, Morgado MT, De Bonis M, Laroche C, Boersma E, Lancellotti P, Habib G. Infective endocarditis in adult patients with congenital heart disease. Int J Cardiol 2023; 370:178-185. [PMID: 36273665 DOI: 10.1016/j.ijcard.2022.10.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.
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Affiliation(s)
- Joost P van Melle
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands.
| | | | - Manish Bansal
- Medanta, The Medicity, Gurgaon, Haryana 120001, India
| | - Otto Kamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands
| | - Marwa Meshaal
- Department of Cardiology, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Jiri Pudich
- Department of Cardiovascular Diseases, University Hospital Ostrava, University of Ostrava, Faculty of Medicine, Czech Republic
| | - Vlatka Reskovic Luksic
- Department of Cardiovascular Diseases, University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Croatia
| | | | - Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran; Duke Cardiovascular MR Center, Durham, NC, United States of America
| | - Jadranka Separovic Hanzevacki
- Department of Cardiovascular Diseases, University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Croatia
| | - Rouguiatou Sow
- Department of Cardiology, Laboratory of Echocardiography, Luxembourg Hospital Centre, Luxembourg
| | - Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Marisa Trabulo Morgado
- Cardiology Department, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Michele De Bonis
- Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Heart House. 2035 Route des Colles, CS80179 Biot, 06903 Sophia-Antipolis, France
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- La Timone Hospital, Cardiology Department, Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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12
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Sun BJ, Song JK. Bicuspid aortic valve: evolving knowledge and new questions. Heart 2022; 109:10-17. [PMID: 35264416 DOI: 10.1136/heartjnl-2021-320008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
Bicuspid aortic valve (BAV), a common congenital anomaly with various morphological phenotypes, is also characterised by marked heterogeneity in clinical presentations including clinically silent condition with mild valvulo-aortopathy, progressive valvulopathy and complex valvulo-aortopathy with shorter life expectancy. The clinical importance of using a general and unified nosology for BAV is well-accepted by opinion leaders and an international consensus statement has been recently published, which will serve as an important scientific platform for BAV. This review describes the current knowledge of BAV based on clinical studies, addresses several unresolved issues requiring investigators' attention and highlights the necessity of prospective studies with a very long follow-up duration for better appreciation of BAV-associated valvulo-aortopathy. In addition, the progression of valvular calcification in patients with BAV and its potential contribution to development of valvulopathy will be discussed.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jae-Kwan Song
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, South Korea .,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, South Korea
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13
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Kusner JJ, Brown JY, Gleason TG, Edelman ER. The Natural History of Bicuspid Aortic Valve Disease. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Bicuspid Aortic Valve in Children and Adolescents: A Comprehensive Review. Diagnostics (Basel) 2022; 12:diagnostics12071751. [PMID: 35885654 PMCID: PMC9319023 DOI: 10.3390/diagnostics12071751] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect. Prevalence of isolated BAV in the general pediatric population is about 0.8%, but it has been reported to be as high as 85% in patients with aortic coarctation. A genetic basis has been recognized, with great heterogeneity. Standard BAV terminology, recently proposed on the basis of morpho-functional assessment by transthoracic echocardiography, may be applied also to the pediatric population. Apart from neonatal stenotic BAV, progression of valve dysfunction and/or of the associated aortic dilation seems to be slow during pediatric age and complications are reported to be much rarer in comparison with adults. When required, because of severe BAV dysfunction, surgery is most often the therapeutic choice; however, the ideal initial approach to treat severe aortic stenosis in children or adolescents is not completely defined yet, and a percutaneous approach may be considered in selected cases as a palliative option in order to postpone surgery. A comprehensive and tailored evaluation is needed to define the right intervals for cardiologic evaluation, indications for sport activity and the right timing for intervention.
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15
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Baumann AAW, Montarello NJ, Young GD. Abdominal discomfort leading to the incidental finding of complete heart block. Med J Aust 2022; 216:340-342. [DOI: 10.5694/mja2.51469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/01/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Angus AW Baumann
- Central Adelaide Local Health Network Adelaide SA
- MonashHeart, Monash Medical Centre Melbourne VIC
- Alice Springs Hospital Alice Springs NT
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16
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2499] [Impact Index Per Article: 1249.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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17
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Recurrent fever and anemia as manifestations of infective endocarditis in a 13-year-old girl with bicuspid aortic valve. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh200412046p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction Infective endocarditis is relatively rare in pediatric
population, but can result in significant morbidity and mortality. Children
with bicuspid aortic valve are at higher risk of developing infective
endocarditis as compared to general population. Our objective is to
emphasize the importance of rapid diagnosis and proper treatment of
infective endocarditis in patients with bicuspid aortic valve with aim to
prevent serious adverse events. Case outline We report a case of a
13-year-old girl with newly diagnosed bicuspid aortic valve who developed
infective endocarditis with severe complications and underwent cardiac
surgery. Recurrent fever and anemia, as well as cardiac murmur were present
for six months prior to diagnosing infective endocarditis. During the course
of illness, only one of many blood cultures taken was positive for
Streptococus sanguinis. Conclusion Patients with bicuspid aortic valve
require careful evaluation for infective endocarditis, especially if anemia
is associated with recurrent fever. Delayed diagnosis of infective
endocarditis in patients with bicuspid aortic valve is associated with
severe complications.
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18
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Hassler KR, Michelena HI, Crestanello JA. Commentary: Bicuspid aortic valves and infective endocarditis: A real problem without clear solutions. JTCVS OPEN 2021; 8:237-238. [PMID: 36004122 PMCID: PMC9390488 DOI: 10.1016/j.xjon.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/02/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
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19
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Kim K, Kim DY, Seo J, Cho I, Hong GR, Ha JW, Shim CY. Temporal Trends in Diagnosis, Treatments, and Outcomes in Patients With Bicuspid Aortic Valve. Front Cardiovasc Med 2021; 8:766430. [PMID: 34805321 PMCID: PMC8599961 DOI: 10.3389/fcvm.2021.766430] [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: 08/29/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The population is aging and advances in multimodal imaging and transcatheter valve intervention have been prominent in the past two decades. This study investigated temporal trends in demographic characteristics, use of multimodal imaging, treatments, and outcomes in patients with bicuspid aortic valve (BAV). Methods and Results: A total of 1,497 patients (male 71.7%, 57 ± 14 years old) first diagnosed with BAV between January 2003 and December 2020, in a single tertiary center were divided into three groups according to year of diagnosis: group 1 (2003-2008, n = 269), group 2 (2009-2014, n = 594), and group 3 (2015-2020, n = 634). The patients' demographic characteristics, comorbidities, BAV morphology, BAV function, BAV-related disease, use of multimodal diagnostic imaging, treatment modality for BAV, and clinical outcomes were compared among the three groups. The ages at diagnosis and at the time of surgery/intervention increased considerably from group 1 to 3. The patients' comorbidity index also increased progressively. The proportion of non-dysfunctional BAV and significant AS increased, while that of significant AR decreased. The frequency of infective endocarditis as an initial presentation significantly decreased over time. Additionally, the use of multimodal imaging increased markedly in the most recent group. The results also indicated increasing trends in the use of bioprosthetic valves and transcatheter aortic valve replacement. Overall and cardiovascular survival rates improved from group 1 to 3 (log rank p < 0.001). Conclusions: For the past two decades, remarkable temporal changes have occurred in patient characteristics, use of multimodal diagnostic imaging, choice of treatment modality, and clinical outcomes in patients with BAV.
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Affiliation(s)
- Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae-Young Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jiwon Seo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
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20
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Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, Couper DJ, Beaton A, Kilmartin C, Miro JM, Sable C, Jackson MA, Baddour LM. Adapted from: Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. J Am Dent Assoc 2021; 152:886-902.e2. [PMID: 34711348 DOI: 10.1016/j.adaj.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2007, the American Heart Association published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent viridans group streptococcal (VGS) infective endocarditis (IE) in cardiac patients undergoing invasive procedures. The 2007 guidelines significantly scaled back the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories thought to confer the highest risk of adverse outcome. The purpose of this update is to examine interval evidence of the acceptance and impact of the 2007 recommendations on VGS IE and, if needed, to make revisions based on this evidence. METHODS AND RESULTS A writing group was formed consisting of experts in prevention and treatment of infective endocarditis including members of the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, in addition to the American Heart Association. MEDLINE database searches were done for English language articles on compliance with the recommendations in the 2007 guidelines and the frequency of and morbidity or mortality from VGS IE after publication of the 2007 guidelines. Overall, there was good general awareness of the 2007 guidelines but variable compliance with recommendations. There was no convincing evidence that VGS IE frequency, morbidity, or mortality has increased since 2007. CONCLUSIONS On the basis of a review of the available evidence, there are no recommended changes to the 2007 VGS IE prevention guidelines. We continue to recommend VGS IE prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all. Randomized controlled studies to determine whether antibiotic prophylaxis is effective against VGS IE are needed to further refine recommendations.
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21
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Richter EW, Shehata IM, Elsayed-Awad HM, Klopman MA, Bhandary SP. Mitral Regurgitation in Patients Undergoing Noncardiac Surgery. Semin Cardiothorac Vasc Anesth 2021; 26:54-67. [PMID: 34467794 DOI: 10.1177/10892532211042827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College of Cardiologists (ACC) and the American Heart Association (AHA) that inform decision-making for the anesthesiologist caring for a patient with MR undergoing noncardiac surgery. The pathophysiology and natural history of acute and chronic MR, staging of chronic primary and secondary MR, and considerations for timing of valvular corrective surgery are reviewed. These topics are then applied to a discussion of anesthetic management, including preoperative risk evaluation, anesthetic selection, hemodynamic goals, and intraoperative monitoring of the noncardiac surgical patient with MR.
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22
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Morningstar JE, Nieman A, Wang C, Beck T, Harvey A, Norris RA. Mitral Valve Prolapse and Its Motley Crew-Syndromic Prevalence, Pathophysiology, and Progression of a Common Heart Condition. J Am Heart Assoc 2021; 10:e020919. [PMID: 34155898 PMCID: PMC8403286 DOI: 10.1161/jaha.121.020919] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023]
Abstract
Mitral valve prolapse (MVP) is a commonly occurring heart condition defined by enlargement and superior displacement of the mitral valve leaflet(s) during systole. Although commonly seen as a standalone disorder, MVP has also been described in case reports and small studies of patients with various genetic syndromes. In this review, we analyzed the prevalence of MVP within syndromes where an association to MVP has previously been reported. We further discussed the shared biological pathways that cause MVP in these syndromes, as well as how MVP in turn causes a diverse array of cardiac and noncardiac complications. We found 105 studies that identified patients with mitral valve anomalies within 18 different genetic, developmental, and connective tissue diseases. We show that some disorders previously believed to have an increased prevalence of MVP, including osteogenesis imperfecta, fragile X syndrome, Down syndrome, and Pseudoxanthoma elasticum, have few to no studies that use up-to-date diagnostic criteria for the disease and therefore may be overestimating the prevalence of MVP within the syndrome. Additionally, we highlight that in contrast to early studies describing MVP as a benign entity, the clinical course experienced by patients can be heterogeneous and may cause significant cardiovascular morbidity and mortality. Currently only surgical correction of MVP is curative, but it is reserved for severe cases in which irreversible complications of MVP may already be established; therefore, a review of clinical guidelines to allow for earlier surgical intervention may be warranted to lower cardiovascular risk in patients with MVP.
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Affiliation(s)
- Jordan E. Morningstar
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Annah Nieman
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Christina Wang
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Tyler Beck
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Andrew Harvey
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
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23
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Tessler I, Leshno M, Shmueli A, Shpitzen S, Ronen D, Gilon D. Cost-effectiveness analysis of screening for first-degree relatives of patients with bicuspid aortic valve. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:447-457. [PMID: 34227670 DOI: 10.1093/ehjqcco/qcab047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/25/2022]
Abstract
AIMS Bicuspid aortic valve (BAV) is the commonest congenital heart valve malformation, and is associated with life-threatening complications. Given the high heritability index of BAV, many experts recommend echocardiography screening for first-degree relatives (FDRs) of an index case. Here we aim to evaluate the cost-effectiveness of such cascade screening for BAV. METHODS Using a decision-analytic model, we performed a cost-effectiveness analysis of echocardiographic screening for FDRs of BAV index case. Data on BAV probabilities and complications among FDRs were derived from our institution's BAV familial cohort and from the literature on population-based BAV cohorts with long-term follow-up. Health gain was measured as quality-adjusted life years (QALYs). Cost inputs were based on list prices and literature data. One-way and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables. RESULTS Screening of FDRs was found to be the dominant strategy, being more effective and less costly than no screening, with savings of €644 and gains of 0.3 QALYs. Results were sensitive throughout the rang of the model's variables, including the full range of reported BAV rates among FDRs across the literature. A gradual decrease of the incremental effect was found with the increase in screening age. CONCLUSIONS This economic evaluation model found that echocardiographic screening of FDRs of BAV index case is not only clinically important but also cost-effective and cost-saving. Sensitivity analysis supported the model's robustness, suggesting its generalization.
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Affiliation(s)
- Idit Tessler
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel.,Heart institute, Hadassah Medical Center, Jerusalem, Israel
| | - Moshe Leshno
- Faculty of Management and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shmueli
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Shoshana Shpitzen
- Heart institute, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Durst Ronen
- Heart institute, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Dan Gilon
- Heart institute, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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24
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Mahdi M, Ozer M, Nagra B, Aufiero P, Kantharia B. Acquired Gerbode Defect in a Patient With Infective Endocarditis of Bicuspid Aortic Valve. Cureus 2021; 13:e15352. [PMID: 34239786 PMCID: PMC8244663 DOI: 10.7759/cureus.15352] [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] [Accepted: 05/31/2021] [Indexed: 11/05/2022] Open
Abstract
Aortic valve abscess is a fatal complication of infective endocarditis. Transthoracic echocardiography is the initial imaging obtained in suspected infective endocarditis. However, its accuracy in detecting cardiac complications remains low, thus should be followed by transesophageal echocardiography if the clinical situation permits. Here, we present a case of a bicuspid aortic valve infective endocarditis caused by Streptococcus agalactiae and complicated with aortic valve abscess and acquired Gerbode defect, which appeared as a tricuspid valve vegetation on transthoracic echocardiography.
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Affiliation(s)
- Mohammed Mahdi
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Muhammet Ozer
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
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25
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Raja Shariff REF, Zainal Abidin HA, Kasim S. Bicuspid aortic valve infective endocarditis and aortic root abscess presenting initially as splenic infarctions. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211019438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infective endocarditis (IE) commonly complicates bicuspid aortic valve. We report an uncommon case of bicuspid aortic valve (BAV) IE with aortic root abscess (ARA), presenting initially with abdominal pain due to splenic infarcts, delaying prompt diagnosis. A 38-year-old gentleman presented with fever and abdominal pain. He was treated for intra-abdominal sepsis, was started on intravenous antibiotics and had a computed tomography scan of the abdomen that revealed a large splenic infarct. The patient deteriorated, prompting further investigations, including echocardiography due to findings of a new murmur, signs of embolisation and blood cultures revealing Staphylococcus aureus. This revealed an otherwise unknown BAV with aortic valve vegetation and ARA. IE and ARA commonly affect patients with bicuspid aortic valve, and our case highlights the importance of systemic review, as IE often manifest clinically in various forms.
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26
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Niaz T, Johnson JN, Cetta F, Olson TM, Hagler DJ. Bicuspid Aortic Valve in Infants, Children, and Adolescents: A Review for Primary Care Providers. Pediatr Rev 2021; 42:233-244. [PMID: 33931508 DOI: 10.1542/pir.2019-0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Frank Cetta
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Timothy M Olson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Donald J Hagler
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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27
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Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, Couper DJ, Beaton A, Kilmartin C, Miro JM, Sable C, Jackson MA, Baddour LM. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e963-e978. [PMID: 33853363 DOI: 10.1161/cir.0000000000000969] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2007, the American Heart Association published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent viridans group streptococcal (VGS) infective endocarditis (IE) in cardiac patients undergoing invasive procedures. The 2007 guidelines significantly scaled back the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories thought to confer the highest risk of adverse outcome. The purpose of this update is to examine interval evidence of the acceptance and impact of the 2007 recommendations on VGS IE and, if needed, to make revisions based on this evidence. METHODS AND RESULTS A writing group was formed consisting of experts in prevention and treatment of infective endocarditis including members of the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, in addition to the American Heart Association. MEDLINE database searches were done for English language articles on compliance with the recommendations in the 2007 guidelines and the frequency of and morbidity or mortality from VGS IE after publication of the 2007 guidelines. Overall, there was good general awareness of the 2007 guidelines but variable compliance with recommendations. There was no convincing evidence that VGS IE frequency, morbidity, or mortality has increased since 2007. CONCLUSIONS On the basis of a review of the available evidence, there are no recommended changes to the 2007 VGS IE prevention guidelines. We continue to recommend VGS IE prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all. Randomized controlled studies to determine whether antibiotic prophylaxis is effective against VGS IE are needed to further refine recommendations.
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28
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Toader D, Cocora M, Bătăiosu C, Ocroteală L. A rare case of anaerobic streptococci endocarditis in a young female with bicuspid aortic valve: case report. Eur Heart J Case Rep 2021; 5:ytaa452. [PMID: 33554013 PMCID: PMC7850613 DOI: 10.1093/ehjcr/ytaa452] [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: 04/29/2020] [Revised: 06/09/2020] [Accepted: 11/05/2020] [Indexed: 12/05/2022]
Abstract
BACKGROUND Bicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1-2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality. CASE SUMMARY We report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up. DISCUSSION This is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The 'take away' message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.
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Affiliation(s)
- Despina Toader
- Department of Cardiology, Craiova Cardiology Center, EuroEchoLab, Str Tabaci nr1, Craiova, Romania
| | - Mioara Cocora
- Cardiovascular Surgery Department, Institute of Cardiovascular Disease, Timișoara, Romania
| | - Constantin Bătăiosu
- Department of Interventional Cardiology, Craiova Cardiology Center, Craiova, Romania
| | - Luminiă Ocroteală
- Department of Hematology, Municipal Hospital Craiova, Craiova, Romania
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CANDAN M. INFECTIVE ENDOCARDITIS PROPHYLAXIS IN DENTISTRY : CURRENT PERSPECTIVE. CUMHURIYET DENTAL JOURNAL 2020. [DOI: 10.7126/cumudj.825256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Update on Bicuspid Aortic Valve Syndrome: Patient Selection and Therapies in 2020. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Talha KM, DeSimone DC, Sohail MR, Baddour LM. Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis. Heart 2020; 106:1878-1882. [PMID: 32847941 DOI: 10.1136/heartjnl-2020-317034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase 'subacute bacterial endocarditis', so-called 'SBE', was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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Niaz T, Fernandes SM, Sanders SP, Michelena H, Hagler DJ. Clinical history and management of bicuspid aortic valve in children and adolescents. Prog Cardiovasc Dis 2020; 63:425-433. [PMID: 32497585 DOI: 10.1016/j.pcad.2020.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bicuspid aortic valve (BAV) is one of the most common congenital heart defects in children, adolescents and adults. BAV can occur as an isolated lesion or in association with other congenital heart defects, such as coarctation of the aorta or genetic syndromes like Turner syndrome. Although the majority of long term complications associated with BAV manifest later in life, children and adolescents may present with early onset valvular dysfunction or dilation of the aorta. BAV is a heterogeneous disease with a wide array of presentations at various ages, depending on the degree of aortic valve dysfunction, aortic dilation and presence of associated lesions. Aortic valve stenosis and/or regurgitation are the primary indications for intervention in children and adolescents with BAV. Although a majority of young patients with BAV also have some aortic dilation, interventions on the aorta are very rare during this time frame. Children and adolescents with BAV benefit from comprehensive assessment of their risk profile to determine follow-up surveillance intervals, sports recommendations, and timing of surgical intervention. The morphologic phenotype of BAV is important to identify, as it may predict future complications and prognosis.
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Affiliation(s)
- Talha Niaz
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, United States of America
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, United States of America; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, United States of America
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Hector Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Donald J Hagler
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, United States of America; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
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Floppy mitral valve/mitral valve prolapse: A complex entity with multiple genotypes and phenotypes. Prog Cardiovasc Dis 2020; 63:308-326. [DOI: 10.1016/j.pcad.2020.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 01/20/2023]
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Wang Y, Wu B, Li J, Liu H, Shu X. Distribution Patterns of Valvular and Vascular Complications in Bicuspid Aortic Valve. Int Heart J 2020; 61:273-280. [DOI: 10.1536/ihj.19-467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yongshi Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
- Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University
| | - Boting Wu
- Department of Transfusion, Zhongshan Hospital, Fudan University
| | - Jun Li
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | | | - Xianhong Shu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
- Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University
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36
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Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction. Case Rep Infect Dis 2020; 2020:5314503. [PMID: 32231819 PMCID: PMC7086409 DOI: 10.1155/2020/5314503] [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] [Received: 06/19/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022] Open
Abstract
A 38-year-old male presented to the emergency department (ED) complaining of extreme pain and a petechial rash on the left ankle for two weeks associated with generalized fatigue, intermittent fevers, and weight loss. He was discharged home from the ED on pain medications. He returned a few days later with a progressive rash that involved the entire left lower extremity to the level of the knee. He was diagnosed with herpes zoster (shingles) and was prescribed acyclovir and steroids. After several days, the patient presented for the third time to the ED. He developed a right lower extremity discomfort this time. The pain in bilateral lower extremities had become unbearable. His cardiac examination revealed a systolic murmur at the apex and a faint diastolic murmur at the left sternal border. Ultimately, he had an echocardiogram that demonstrated both a bicuspid aortic valve and large vegetation on the anterior leaflet of the mitral valve, and his blood culture grew Streptococcus mitis and Streptococcus oralis. The patient was subsequently diagnosed with subacute bacterial endocarditis thought to be sourced from his poor dentition. The diagnosis of infective endocarditis is often delayed due to its nonspecific clinical presentations. Our case displays an unusual skin manifestation of IE that may be present in the absence of other signs and symptoms of the disease.
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4861] [Impact Index Per Article: 1215.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Sadeghpour A, Maleki M, Movassaghi M, Rezvani L, Noohi F, Boudagh S, Ghadrdoost B, Bakhshandeh H, Alizadehasl A, Naderi N, Kamali M, Ghavidel AA, Peighambari MM, Kyavar M, Pasha H. Iranian Registry of Infective Endocarditis (IRIE): Time to relook at the guideline, regarding to regional differences. IJC HEART & VASCULATURE 2019; 26:100433. [PMID: 31737777 PMCID: PMC6849153 DOI: 10.1016/j.ijcha.2019.100433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022]
Abstract
Aims Infective endocarditis (IE) remained a potentially fatal disease with high rate of mortality and morbidity. The epidemiology and global burden of IE are largely different between the countries. We aimed to address the epidemiological aspects of IE in a tertiary hospital in Tehran, Iran. Methods and Results Between 2006–2018, all adults patients with diagnosis of IE were enrolled in the Iranian Registry of Infective Endocarditis (IRIE). The data were analyzed using the χ2, Kolmogorov–Smirnov, and Mann–Whitney U tests. Overall, 602 patients, 407 (67.6%) men, mean age 46 ± 16 years were recruited. Positive blood culture found in 49%.The most common underlying heart diseases were: Congenital heart diseases (CHD) particularly bicuspid aortic valves (BAV) and ventricular septal defects (VSD) in 37%, followed by degenerative heart diseases :flail and mitral valve prolapse (16.3%), intravenous drug user in 12.6%, prosthetic valves in 11.1%, previous IE (8.9%), rheumatic heart diseases (RHD) in 8.4%. The most causative microorganisms were Staphylococcus aureus, Enterococci, coagulase-negative staphylococci and Streptococcus viridans. Cardiac or extra cardiac complications occurred in 56.6% of the patients. Conclusions Based on IRIE, IE occurs in the younger population in Iran with high rates of blood culture-negative IE. RHD are not the main cause of IE in Iran, CHD including BAV and VSDs, followed by prolaptic or flail mitral valve were the most common. These 2 groups can be considered a high-risk group for IE. More than half of the patients with IE had cardiac or extra cardiac complications.
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Affiliation(s)
- Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Massoud Movassaghi
- Department of Pathology and Laboratory Medicine, USC/LAC+USC Medical Center, Los Angeles, CA, USA
| | | | - Feridoun Noohi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Boudagh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Monireh Kamali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza A Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Peighambari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Kyavar
- Cardiovascular Intervention Research Center Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pasha
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Carasso S, Amy DPB, Kusniec F, Ghanim D, Sudarsky D, Kinany W, Shmuel C, Abu El-Naaj I, Kachel E, Amir O. Dental screening prior to valve interventions: Should we prepare transcatheter aortic valve replacement candidates for "surgery"? Int J Cardiol 2019; 294:23-26. [PMID: 31378381 DOI: 10.1016/j.ijcard.2019.07.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/01/2019] [Accepted: 07/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND 40% of cases of infective endocarditis (IE) are likely caused by oral bacteria. IE prevalence after transcatheter aortic valve replacement (TAVR) is comparable to IE following surgical prosthetic valve replacement (SVR). Current guidelines recommend pre-operative dental screening for SVR, without specific recommendations regarding TAVR. We aimed to compare oral dental findings in TAVR vs. surgical valve replacement (SVR) candidates and assess the need for routine dental screening and treatment prior to TAVR similar to the SVR patients. METHODS 150 patients (58 TAVR candidates and 92 surgical candidates) were all referred for screening and appropriate treatment before intervention to our Oral medicine team, blinded to the planned interventional type. All patients were scored for oral hygiene and dental findings that required intervention. An oral health score (OHS, general hygiene: 0-good, 1-bad, need for immediate treatment: 0-no, 1-yes, need for future treatment: 0-no, 1-yes) was calculated and compared. Patients were clinically followed for IE for 14 ± 5 months (rage 8-28) post intervention. RESULTS While candidates for SVR were younger than TAVR (66 + 10 vs. 81 ± 6 respectively, P < 0.0001), oral-dental findings were similar. OHS was 1.6 for SVR and 1.7 for TAVR candidates, p = 0.45). Half of patients in either group had findings requiring pre-procedural dental treatment. There were two IE cases during follow-up, one in each group. CONCLUSION Oral health and need for pre-procedural dental treatment were not different among candidates for SVR and TAVR. IE preventive oral-dental care seems to be justified in patients undergoing TAVR initially denied SVR due to prohibitive operative risk.
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Affiliation(s)
- Shemy Carasso
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel.
| | - Dalit Porat Ben Amy
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Fabio Kusniec
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Diab Ghanim
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Doron Sudarsky
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Wadi Kinany
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Chen Shmuel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Imad Abu El-Naaj
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral and Cranio-maxillofacial surgery Department, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Erez Kachel
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Offer Amir
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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Affiliation(s)
- Jose M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
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Chambers JB. Antibiotic Prophylaxis Against Infective Endocarditis: Widening the Net? J Am Coll Cardiol 2019; 71:2741-2743. [PMID: 29903347 DOI: 10.1016/j.jacc.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- John B Chambers
- Cardiothoracic Centre, Guy's and St. Thomas' Hospitals, London, United Kingdom.
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42
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Affiliation(s)
- Gail E Peterson
- University of Texas Southwestern Medical Center, Dallas (G.E.P.)
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43
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Calcaterra G, Crisafulli A, Guccione P, Di Salvo G, Bassareo PP. Infective endocarditis triangle.. Is it the time to revisit infective endocarditis susceptibility and indications for its antibiotic prophylaxis? Eur J Prev Cardiol 2019; 26:1771-1774. [PMID: 31180759 DOI: 10.1177/2047487319856126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Antonio Crisafulli
- Department of Medical Sciences and Public Health, Sports Physiology Laboratory, University of Cagliari, Italy
| | - Paolo Guccione
- Department of Paediatric Cardiology and Cardiac Surgery Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Giovanni Di Salvo
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College of London, UK
| | - Pier P Bassareo
- University College of Dublin, Mater Misericordiae University Hospital, Republic of Ireland
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Wang J, Abhinav P, Xu YJ, Li RG, Zhang M, Qiu XB, Di RM, Qiao Q, Li XM, Huang RT, Xue S, Yang YQ. NR2F2 loss‑of‑function mutation is responsible for congenital bicuspid aortic valve. Int J Mol Med 2019; 43:1839-1846. [PMID: 30720060 DOI: 10.3892/ijmm.2019.4087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/22/2019] [Indexed: 11/06/2022] Open
Abstract
Congenital bicuspid aortic valve (BAV) represents the most common type of cardiac birth defect affecting 0.4‑2% of the general population, and accounts for a markedly increased incidence of life‑threatening complications, including valvulopathy and aortopathy. Accumulating evidence has demonstrated the genetic basis of BAV. However, the genetic basis for BAV in the majority of cases remains to be elucidated. In the present study, the coding regions and splicing donors/acceptors of the nuclear receptor subfamily 2 group F member 2 (NR2F2) gene, which encodes a transcription factor essential for proper cardiovascular development, were sequenced in 176 unrelated cases of congenital BAV. The available family members of the proband carrying an identified NR2F2 mutation and 280 unrelated, sex‑ and ethnicity‑matched healthy individuals as controls were additionally genotyped for NR2F2. The functional effect of the mutation was characterized using a dual‑luciferase reporter assay system. As a result, a novel heterozygous NR2F2 mutation, NM_021005.3: c.288C>A; p.(Cys96*), was identified in a family with BAV, which was transmitted in an autosomal dominant mode with complete penetrance. The nonsense mutation was absent from the 560 control chromosomes. Functional analysis identified that the mutant NR2F2 protein had no transcriptional activity. Furthermore, the mutation disrupted the synergistic transcriptional activation between NR2F2 and transcription factor GATA‑4, another transcription factor that is associated with BAV. These findings suggested NR2F2 as a novel susceptibility gene of human BAV, which reveals a novel molecular pathogenesis underpinning BAV.
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Affiliation(s)
- Juan Wang
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Pradhan Abhinav
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Ying-Jia Xu
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
| | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
| | - Ruo-Min Di
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Qi Qiao
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Xiu-Mei Li
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Ri-Tai Huang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Song Xue
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Yi-Qing Yang
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
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Liu T, Xie M, Lv Q, Li Y, Fang L, Zhang L, Deng W, Wang J. Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment. Front Physiol 2019; 9:1921. [PMID: 30761020 PMCID: PMC6363677 DOI: 10.3389/fphys.2018.01921] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
The bicuspid aortic valve, a kind of heart disease that comes from parents, has been paid attention around the world. Although most bicuspid aortic valve (BAV) patients will suffer from some complications including aortic stenosis, aortic regurgitation, endocarditis, and heart dysfunction in the late stage of the disease, there is none symptom in the childhood, which restrains us to diagnose and treatment in the onset phase of BAV. Hemodynamic abnormalities induced by the malformations of the valves in BAV patients for a long time will cause BAV-associated aortopathy: including progress aortic dilation, aneurysm, dissection and rupture, cardiac cyst and even sudden death. At present, preventive surgical intervention is the only effective method used in this situation and the diameter of the aorta is the primary reference criterion for surgery. And the treatment effects are always not satisfactory for patients and clinicians. Therefore, we need more methods to evaluate the progression of BAV and the surgery value and the appropriate intervention time by combining basic research with clinical treatment. In this review, advances in morphology, genetic, biomarkers, diagnosis and treatments are summarized, which expects to provide an update about BAV. It is our supreme expectations to provide some evidences for BAV early screening and diagnosis, and in our opinion, personalized surgical strategy is the trend of future BAV treatment.
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Affiliation(s)
- Tianshu Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenhui Deng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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46
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Maraki S, Plevritaki A, Kofteridis D, Scoulica E, Eskitzis A, Gikas A, Panagiotakis SH. Bicuspid aortic valve endocarditis caused by Gemella sanguinis: Case report and literature review. J Infect Public Health 2019; 12:304-308. [PMID: 30670353 DOI: 10.1016/j.jiph.2019.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 11/16/2022] Open
Abstract
Gemella species are catalase-negative, facultative anaerobic, Gram-positive cocci, which are part of the human oral microbiome and may occasionally cause systemic infections. Infective endocarditis (IE) has been reported as the most common infection caused by Gemella species. We report the first case of IE due to Gemella sanguinis in Greece, in a patient with bicuspid aortic valve and review the available literature. The patient was successfully treated with antibiotics and aortic valve replacement.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Anthoula Plevritaki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Effie Scoulica
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Anastasios Eskitzis
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Achilleas Gikas
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Symeon H Panagiotakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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47
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Anguita P, Castillo JC, Herrera M, Anguita M. Análisis de la situación de la profilaxis de la endocarditis infecciosa en odontología tras casi una década de guías de práctica clínica. Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Anguita P, Castillo JC, Herrera M, Anguita M. Prophylaxis of Infective Endocarditis in Dentistry: Analysis of the Situation After Almost a Decade of Clinical Practice Guidelines. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:96. [PMID: 30297277 DOI: 10.1016/j.rec.2018.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Paula Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Cardiodental, Córdoba, Spain
| | - Juan C Castillo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Manuela Herrera
- Facultad de Odontología, Universidad de Sevilla, Sevilla, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Cardiodental, Córdoba, Spain.
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49
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Thornhill MH, Gibson TB, Cutler E, Dayer MJ, Chu VH, Lockhart PB, O'Gara PT, Baddour LM. Antibiotic Prophylaxis and Incidence of Endocarditis Before and After the 2007 AHA Recommendations. J Am Coll Cardiol 2018; 72:2443-2454. [PMID: 30409564 DOI: 10.1016/j.jacc.2018.08.2178] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The American Heart Association updated its recommendations for antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) in 2007, advising that AP cease for those at moderate risk of IE, but continue for those at high risk. OBJECTIVES The authors sought to quantify any change in AP prescribing and IE incidence. METHODS High-risk, moderate-risk, and unknown/low-risk individuals with linked prescription and Medicare or commercial health care data were identified in the Truven Health MarketScan databases from May 2003 through August 2015 (198,522,665 enrollee-years of data). AP prescribing and IE incidence were evaluated by Poisson model analysis. RESULTS By August 2015, the 2007 recommendation change was associated with a significant 64% (95% confidence interval [CI]: 59% to 68%) estimated fall in AP prescribing for moderate-risk individuals and a 20% (95% CI: 4% to 32%) estimated fall for those at high risk. Over the same period, there was a barely significant 75% (95% CI: 3% to 200%) estimated increase in IE incidence among moderate-risk individuals and a significant 177% estimated increase (95% CI: 66% to 361%) among those at high risk. In unknown/low-risk individuals, there was a significant 52% (95% CI: 46% to 58%) estimated fall in AP prescribing, but no significant increase in IE incidence. CONCLUSIONS AP prescribing fell among all IE risk groups, particularly those at moderate risk. Concurrently, there was a significant increase in IE incidence among high-risk individuals, a borderline significant increase in moderate-risk individuals, and no change for those at low/unknown risk. Although these data do not establish a cause-effect relationship between AP reduction and IE increase, the fall in AP prescribing in those at high risk is of concern and, coupled with the borderline increase in IE incidence among those at moderate risk, warrants further investigation.
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Affiliation(s)
- Martin H Thornhill
- Unit of Oral & Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom; Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina.
| | - Teresa B Gibson
- Truven Health Analytics/IBM Watson Health, Ann Arbor, Michigan
| | - Eli Cutler
- Truven Health Analytics/IBM Watson Health, Ann Arbor, Michigan
| | - Mark J Dayer
- Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, Somerset, United Kingdom
| | - Vivian H Chu
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
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50
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DeSimone DC, DeSimone CV, Baddour LM. Infective Endocarditis and Valve-Pathogen Predilection. J Am Coll Cardiol 2018; 72:1558-1559. [DOI: 10.1016/j.jacc.2018.06.073] [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: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
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