1
|
Cabezon G, Pulido P, López Díaz J, de Miguel-Álava M, Vilacosta I, García-Azorin D, Lozano A, Oña A, Arenillas JF, San Román JA. Embolic Events in Infective Endocarditis: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:97. [PMID: 39076945 PMCID: PMC11263858 DOI: 10.31083/j.rcm2503097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 07/31/2024] Open
Abstract
Infective endocarditis (IE) is a life-threating entity with three main complications: heart failure (HF), uncontrolled infection (UI) and embolic events (EEs). HF and UI are the main indications of cardiac surgery and have been studied thoroughly. On the other hand, much more uncertainty surrounds EEs, which have an abrupt and somewhat unpredictable behaviour. EEs in the setting of IE have unique characteristics that must be explored, such as the potential of hemorrhagic transformation of stroke. Accurately predicting which patients will suffer EEs seems to be pivotal to achieve an optimal management of the disease, but this complex process is still not completely understood. The indication of cardiac surgery in order to prevent EEs in the absence of HF or UI is in question as scientific evidence is controversial and mainly of a retrospective nature. This revision addresses these topics and try to summarize the evidence and recommendations about them.
Collapse
Affiliation(s)
- Gonzalo Cabezon
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Paloma Pulido
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Javier López Díaz
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
- Ciber de Enfermedades Cardiovasculares (CIBER CV), Instituto de investigación Carlos III, 28029 Madrid, Spain
| | - María de Miguel-Álava
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Isidre Vilacosta
- Ciber de Enfermedades Cardiovasculares (CIBER CV), Instituto de investigación Carlos III, 28029 Madrid, Spain
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), 28040 Madrid, Spain
| | - David García-Azorin
- Servicio de Neurología del Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Adrian Lozano
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Andrea Oña
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Juan Francisco Arenillas
- Servicio de Neurología del Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - José-Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Cardiology Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
- Ciber de Enfermedades Cardiovasculares (CIBER CV), Instituto de investigación Carlos III, 28029 Madrid, Spain
| |
Collapse
|
2
|
Haddad SF, Lahr BD, El Sabbagh A, Wilson WR, Chesdachai S, DeSimone DC, Baddour LM. Percutaneous mechanical aspiration in patients with right-sided infective endocarditis: An analysis of the national inpatient sample database-2016-2020. Catheter Cardiovasc Interv 2024; 103:464-471. [PMID: 38287781 DOI: 10.1002/ccd.30958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Given the challenges of conventional therapies in managing right-sided infective endocarditis (RSIE), percutaneous mechanical aspiration (PMA) of vegetations has emerged as a novel treatment option. Data on trends, characteristics, and outcomes of PMA, however, have largely been limited to case reports and case series. AIMS The aim of the current investigation was to provide a descriptive analysis of PMA in the United States and to profile the frequency of PMA with a temporal analysis and the patient cohort. METHODS The International Classification of Diseases, 10th Revision codes were used to identify patients with RSIE in the national (nationwide) inpatient sample (NIS) database between 2016 and 2020. The clinical characteristics and temporal trends of RSIE hospitalizations in patients who underwent PMA was profiled. RESULTS An estimated 117,955 RSIE-related hospital admissions in the United States over the 5-year study period were estimated and 1675 of them included PMA. Remarkably, the rate of PMA for RSIE increased 4.7-fold from 2016 (0.56%) to 2020 (2.62%). Patients identified with RSIE who had undergone PMA were young (medial age 36.5 years) and had few comorbid conditions (median Charlson Comorbidity Index, 0.6). Of note, 36.1% of patients had a history of hepatitis C infection, while only 9.9% of patients had a cardiovascular implantable electronic device. Staphylococcus aureus was the predominant (61.8%) pathogen. Concomitant transvenous lead extraction and cardiac valve surgery during the PMA hospitalization were performed in 18.2% and 8.4% of admissions, respectively. The median hospital stay was 19.0 days, with 6.0% in-hospital mortality. CONCLUSIONS The marked increase in the number of PMA procedures in the United States suggests that this novel treatment option has been embraced as a useful tool in select cases of RSIE. More work is needed to better define indications for the procedure and its efficacy and safety.
Collapse
Affiliation(s)
- Sara F Haddad
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
| | - Walter R Wilson
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Nodoushani AY, Wang Y, Datar Y, Mohnot J, Karlson KJ, Edwards NM, Yin K, Dobrilovic N. Association of Intravenous Drug Use and Length of Stay Following Infective Endocarditis. J Surg Res 2023; 282:239-245. [PMID: 36332302 DOI: 10.1016/j.jss.2022.10.004] [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: 03/13/2022] [Revised: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Intravenous drug use (IVDU) and associated infective endocarditis (IE) has been on the rise in the US since the beginning of the opioid epidemic. IVDU-IE has high morbidity and mortality, and treatment can be lengthy. We aim to quantify the association between IVDU and length of stay (LOS) in IE patients. METHODS The National Inpatient Sample database was used to identify IE patients, which was then stratified into IVDU-IE and non-IVDU-IE groups. Weighted values of hospitalizations were used to generate national estimates. Multivariable linear and logistic regression analyses were applied to estimate the effects of IVDU on LOS. RESULTS We identified 1,114,257 adult IE patients, among which 123,409 (11.1%) were IVDU-IE. Compared to non-IVDU-IE patients, IVDU-IE patients were younger, had fewer comorbidities, and had an overall longer LOS (median [interquartile range]: 10 [5-20] versus 7 [4-13] d, P < 0.001), with a greater percentage of patients with a LOS longer than 30 d (13.7% versus 5.7%, P < 0.001). After adjusting for multiple demographic and clinical factors, IVDU was independently associated with a 1.25-d increase in LOS (beta-coefficient = 1.25, 95% confidence interval [CI]: 0.95-1.54, P < 0.001) and 35% higher odds of being hospitalized for more than 30 d (odds ratio = 1.35, 95% CI: 1.27-1.44, P < 0.001). CONCLUSIONS Among IE patients, being IVDU has associated with a longer LOS and a higher risk of prolonged hospital stay. Steps toward the prevention of IE in the IVDU population should be taken to avoid an undue burden on the healthcare system.
Collapse
Affiliation(s)
- Ariana Y Nodoushani
- Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Yunda Wang
- Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Yesh Datar
- Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Joy Mohnot
- Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Karl J Karlson
- Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Niloo M Edwards
- Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kanhua Yin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Nikola Dobrilovic
- Division of Cardiac Surgery, NorthShore University HealthSystem, Chicago, Illinois.
| |
Collapse
|
4
|
Li J, Ruegamer T, Brochhausen C, Menhart K, Hiergeist A, Kraemer L, Hellwig D, Maier LS, Schmid C, Jantsch J, Schach C. Infective Endocarditis: Predictive Factors for Diagnosis and Mortality in Surgically Treated Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9120467. [PMID: 36547464 PMCID: PMC9788195 DOI: 10.3390/jcdd9120467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Diagnosis of infective endocarditis (IE) often is challenging, and mortality is high in such patients. Our goal was to characterize common diagnostic tools to enable a rapid and accurate diagnosis and to correlate these tools with mortality outcomes. Methods: Because of the possibility of including perioperative diagnostics, only surgically treated patients with suspected left-sided IE were included in this retrospective, monocentric study. A clinical committee confirmed the diagnosis of IE. Results: 201 consecutive patients (age 64 ± 13 years, 74% male) were finally diagnosed with IE, and 14 patients turned out IE-negative. Preoperative tests with the highest sensitivity for IE were positive blood cultures (89.0%) and transesophageal echocardiography (87.5%). In receiver operating characteristics, vegetation size revealed high predictive power for IE (AUC 0.800, p < 0.001) with an optimal cut-off value of 11.5 mm. Systemic embolism was associated with mortality, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) had predictive power for mortality. Conclusion: If diagnostic standard tools remain inconclusive, we suggest employing novel cut-off values to increase diagnostic accuracy and accelerate diagnosis. Patients with embolism or elevated NT-proBNP deserve a closer follow-up.
Collapse
Affiliation(s)
- Jing Li
- Department for Cardiac, Thoracic and Cardiovascular Surgery, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Tamara Ruegamer
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Department for Pathology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Karin Menhart
- Department for Nuclear Medicine, University Heart Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Andreas Hiergeist
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lukas Kraemer
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Dirk Hellwig
- Department for Nuclear Medicine, University Heart Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lars S. Maier
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christof Schmid
- Department for Cardiac, Thoracic and Cardiovascular Surgery, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Köln, Germany
| | - Christian Schach
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-7210; Fax: +49-941-944-7235
| |
Collapse
|
5
|
Dzilic E, Nöbauer C, Burri M, Voss S, Krane M, Lange R, Vitanova K. Surgical treatment of isolated tricuspid valve endocarditis: Midterm data. J Card Surg 2022; 37:2999-3005. [DOI: 10.1111/jocs.16741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/11/2022] [Accepted: 05/04/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Elda Dzilic
- Department of Cardiovascular Surgery, German Heart Centre Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery) Technische Universität München Munich Germany
| | - Christian Nöbauer
- Department of Cardiovascular Surgery, German Heart Centre Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery) Technische Universität München Munich Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Centre Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery) Technische Universität München Munich Germany
| | - Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Centre Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery) Technische Universität München Munich Germany
| | - Markus Krane
- Department of Surgery, Division of Cardiac Surgery Yale University School of Medicine New Haven Connecticut USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery) Technische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research) ‐ Partner Site Munich Heart Alliance Munich Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery) Technische Universität München Munich Germany
| |
Collapse
|
6
|
Luo L, Huang SQ, Liu C, Liu Q, Dong S, Yue Y, Liu KZ, Huang L, Wang SJ, Li HY, Zheng S, Wu ZK. Machine Learning-Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis. J Am Heart Assoc 2022; 11:e025433. [PMID: 35656984 PMCID: PMC9238722 DOI: 10.1161/jaha.122.025433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The early mortality after surgery for infective endocarditis is high. Although risk models help identify patients at high risk, most current scoring systems are inaccurate or inconvenient. The objective of this study was to construct an accurate and easy‐to‐use prediction model to identify patients at high risk of early mortality after surgery for infective endocarditis. Methods and Results A total of 476 consecutive patients with infective endocarditis who underwent surgery at 2 centers were included. The development cohort consisted of 276 patients. Eight variables were selected from 89 potential predictors as input of the XGBoost model to train the prediction model, including platelet count, serum albumin, current heart failure, urine occult blood ≥(++), diastolic dysfunction, multiple valve involvement, tricuspid valve involvement, and vegetation >10 mm. The completed prediction model was tested in 2 separate cohorts for internal and external validation. The internal test cohort consisted of 125 patients independent of the development cohort, and the external test cohort consisted of 75 patients from another center. In the internal test cohort, the area under the curve was 0.813 (95% CI, 0.670–0.933) and in the external test cohort the area under the curve was 0.812 (95% CI, 0.606–0.956). The area under the curve was significantly higher than that of other ensemble learning models, logistic regression model, and European System for Cardiac Operative Risk Evaluation II (all, P<0.01). This model was used to develop an online, open‐access calculator (http://42.240.140.58:1808/). Conclusions We constructed and validated an accurate and robust machine learning–based risk model to predict early mortality after surgery for infective endocarditis, which may help clinical decision‐making and improve outcomes.
Collapse
Affiliation(s)
- Li Luo
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Sui-Qing Huang
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Chuang Liu
- School of Computer Science and Technology Xidian University Xi'an P. R. China
| | - Quan Liu
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Shuohui Dong
- Department of General Surgery Qianfoshan HospitalShandong University Jinan P. R. China
| | - Yuan Yue
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Kai-Zheng Liu
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Lin Huang
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Shun-Jun Wang
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Hua-Yang Li
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Shaoyi Zheng
- Department of Cardiovascular Surgery Nanfang HospitalSouthern Medical University Guangzhou P. R. China
| | - Zhong-Kai Wu
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| |
Collapse
|
7
|
Fava AM, Xu B. Tricuspid valve endocarditis: Cardiovascular imaging evaluation and management. World J Clin Cases 2021; 9:8974-8984. [PMID: 34786381 PMCID: PMC8567522 DOI: 10.12998/wjcc.v9.i30.8974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/23/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Right-sided infective endocarditis is an increasingly recognized disease entity, with tricuspid valve being most frequently involved. Risk factors for tricuspid valve endocarditis (TVIE) include intravenous drug use, cardiac implantable electronic devices and indwelling catheters. Staphylococcus aureus is the predominant causative organism in TVIE. The diagnosis of infective endocarditis (IE) is based on clinical manifestations, blood cultures, and the presence of valvular vegetations detected by echocardiography. Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography. Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE, including pulmonary septic emboli. 18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell, single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices. The aim of this review is to provide an update on TVIE, discussing the role of multimodality imaging in TVIE and the management of these patients.
Collapse
Affiliation(s)
- Agostina M Fava
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| |
Collapse
|
8
|
Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment. J Am Heart Assoc 2020; 9:e017293. [PMID: 32700630 PMCID: PMC7792231 DOI: 10.1161/jaha.120.017293] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
Collapse
Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Felix Thomas
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Nir Flint
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.,Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gayatri Setia
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | | | - Robert J Siegel
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| |
Collapse
|
9
|
Rigau PV, Moral S, Bosch D, Morales M, Frigola JM, Albert X, Robles R, Ballesteros E, Roqué M, Aboal J, Brugada R. Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis. Sci Rep 2020; 10:7179. [PMID: 32346051 PMCID: PMC7188839 DOI: 10.1038/s41598-020-64220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/07/2020] [Indexed: 11/09/2022] Open
Abstract
Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for "NODID" RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008-January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23-167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61-4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14-46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.
Collapse
Affiliation(s)
- Pau Vilardell Rigau
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Sergio Moral
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain.
| | - Daniel Bosch
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Manel Morales
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Josep Maria Frigola
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Xavier Albert
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Rocío Robles
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Esther Ballesteros
- Radiology Department, Centre d´Atenció Primaria Pare Claret, Institut Català de la Salut, Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Ramon Brugada
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| |
Collapse
|