1
|
Biezma MI, Muñoz P, De la Villa S, Fariñas-Álvarez MC, Arnáiz de las Revillas F, Gutierrez-Carretero E, De Alarcón A, Rodríguez-García R, Llopis J, Goenaga MÁ, Gutierrez-Villanueva A, Plata A, Vidal L, Martínez-Sellés M. Infective Endocarditis in Diabetic Patients: A Different Profile with Prognostic Consequences. J Clin Med 2022; 11:jcm11092651. [PMID: 35566777 PMCID: PMC9103728 DOI: 10.3390/jcm11092651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/08/2023] Open
Abstract
Background. Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyze the prognostic relevance of DM-related organ damage. Methods. Retrospective analysis of the Spanish IE Registry (2008−2020). Results. The cohort comprises 5590 IE patients with a mean age of 65.0 ± 15.5 years; 3764 (67.3%) were male. DM was found in 1625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p = 0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs. 924 [23.3%], p < 0.001) and higher one-year mortality (640 [39.4%] vs. 1131 [28.5%], p < 0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs. 321 [28.9%], p < 0.001) and one-year mortality (247 [48.0%] vs. 393 [35.4%], p < 0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16−1.55, p < 0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21−1.59, p < 0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06−1.76, p = 0.015) and one-year mortality (OR = 1.59, 95% CI = 1.26−2.01, p < 0.001) Conclusions. The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage.
Collapse
Affiliation(s)
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- CIBERES (CIBER Enfermedades Respiratorias)—Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Sofía De la Villa
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
| | - Mª Carmen Fariñas-Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, IDIVAL (Instituto de Investigación Sanitaria Valdecilla), CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Universidad de Cantabria, 39008 Santander, Spain
| | - Francisco Arnáiz de las Revillas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, IDIVAL (Instituto de Investigación Sanitaria Valdecilla), CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Universidad de Cantabria, 39008 Santander, Spain
| | - Encarnación Gutierrez-Carretero
- Cardiac Surgery Service, CIBERCV (CIBER Enfermedades Cardiovasculares), Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío Seville, 41013 Sevilla, Spain
| | - Arístides De Alarcón
- Cardiac Surgery Service, CIBERCV (CIBER Enfermedades Cardiovasculares), Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío Seville, 41013 Sevilla, Spain
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Universidad de Oviedo, 33011 Oviedo, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology and Statistics, University of Barcelona, 08007 Barcelona, Spain
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, 20014 San Sebastian, Spain
| | - Andrea Gutierrez-Villanueva
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, 28222 Majadahonda, Spain
| | - Antonio Plata
- UGC Enfermedades Infecciosas, Microbiología y Medicina Preventiva, IBIMA (Instituto de Investigación Biomédica de Málaga), Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Laura Vidal
- Servicio de Cardiología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Manuel Martínez-Sellés
- Escuela de Doctorado, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV (CIBER Enfermedades Cardiovasculares), Universidad Complutense, 28040 Madrid, Spain
- Correspondence:
| | | |
Collapse
|
2
|
Calderón Parra J, De Castro-Campos D, Muñoz García P, Olmedo Samperio M, Marín Arriaza M, De Alarcón A, Gutierrez-Carretero E, Fariñas Alvarez MC, Miró Meda JM, Goneaga Sanchez MÁ, Rodriguez García R, Ojeda Burgos G, Valcarce-Gonzalez Z, Ramos-Martinez A. Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort. Eur J Intern Med 2021; 92:71-78. [PMID: 33980395 DOI: 10.1016/j.ejim.2021.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infective endocarditis (IE) due to non-HACEK bacilli (Haemophilus species, Actinobacillus, Cardiobacterium, Eikenella, or Kingella) is uncommon and poorly described. The objectives of this study were to describe non-HACEK Gram-Negative Bacilli (GNB) IE cases and compare characteristic of IE produced by Enterobacterales and non-fermenting (NF) GNB. METHODS From January 2008 to December 2018, 3910 consecutive patients with definitive IE diagnosis, defined with Modified Duke criteria, either clinical or pathological criteria (e.g. demonstration of non-HACEK GNB in valve culture)were prospectively included. RESULTS A total of 104 IE cases were caused by non-HACEK GNB (2.6%). Compared to IE due to other microorganisms (excluding HACEK GNB), patients with non-HACEK GNB IE presented with higher age (71 years [IQR 62-78] vs 68 years [IQR: 57-77]; p = 0.026), higher proportion of women (52% vs 31.5%, p < 0.001), higher Charlson Index (5 [IQR: 4-8] vs 4 [IQR 3-7], p = 0.003) and higher in-hospital mortality (36.5% vs 27.1%, p = 0.034). Enterobacterales cases were more frequently associated with genitourinary focus (32.8% vs 5.0%, p = 0.001). NFGNB endocarditis more frequently affected right valves (20.0% vs. 6.3%, p = 0.033), had more common healthcare-related acquisition (67.5% vs. 43.7%, p = 0.030) and venous catheter as focus (40.0% vs. 17.2%, p = 0.019). In the multivariant model, factors related with hospital mortality were: age (OR 1.05, 95%CI 1.00-1.09, p = 0.042), prosthetic valve (OR 2.31, 95%CI 0.90-5.88, p = 0.080), and not performing surgery when indicated (OR 3.60, 95%CI 1.17-11.05, p = 0.025).Patients treated with quinolone combination had lower mortality (OR 0.29; 95%CI 0.09-0.96; p = 0.043). CONCLUSION Non-HACEK GNB IE is a rare infection characterized by affecting elderly patients with high comorbidity, nosocomial acquisition and unfavorable outcome. Age, prosthetic valve and not performing surgery when indicated are associated with mortality.
Collapse
Affiliation(s)
- Jorge Calderón Parra
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Patricia Muñoz García
- Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Maria Olmedo Samperio
- Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Mercedes Marín Arriaza
- Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Aristides De Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | | | - Guillermo Ojeda Burgos
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Virgen de la Victoria, Malaga, Spain
| | | | - Antonio Ramos-Martinez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| |
Collapse
|
3
|
Gutierrez-Carretero E, Mayoral-González I, Jesús Morón F, Fernández-Quero M, Domínguez-Rodríguez A, Ordóñez A, Smani T. miR-30b-5p Downregulation as a Predictive Biomarker of Coronary In-Stent Restenosis. Biomedicines 2021; 9:354. [PMID: 33808387 PMCID: PMC8066146 DOI: 10.3390/biomedicines9040354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/26/2021] [Indexed: 12/15/2022] Open
Abstract
In-stent restenosis (ISR) is one of the main limitations of percutaneous coronary intervention (PCI) therapy with drug-eluting stents (DES) implantation. The aim of this study was to determine if circulating microRNAs (miRNAs) have diagnostic capability for determining ISR in a cohort of matched patients. Blood samples were collected from 55 patients who underwent previously PCI and were readmitted for a new coronary angiography. Patients were divided into subgroups comprising patients who presented ISR or not (non-ISR). A microarray analysis determined that up to 49 miRNAs were differentially expressed between ISR and non-ISR patients. Of these, 10 miRNAs are related to vascular smooth muscle and endothelial cells proliferation, migration, and differentiation, well-known hallmarks of vascular remodeling. Additionally, we identified that the expression of miR-30b-5p is significantly lower in serum samples of ISR patients, as compared to non-ISR. A further analysis demonstrated that miR-30b-5p provides better values of the receiver operator characteristic curve than other miRNAs and biochemical parameters. Finally, the in-silico analysis suggests that miR-30b-5p is predicted to target 62 genes involved in different signaling pathways involved in vascular remodeling. In conclusion, we determined for the first time that circulating mi-R30b-5p can reliably prognose restenosis in patient with implanted DES, which could be potentially helpful in the establishment of an early diagnosis and therapy of ISR.
Collapse
Affiliation(s)
- Encarnación Gutierrez-Carretero
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Surgery, Faculty of Medicine, University of Seville, 41009 Sevilla, Spain
- University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - Isabel Mayoral-González
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Surgery, Faculty of Medicine, University of Seville, 41009 Sevilla, Spain
| | - Francisco Jesús Morón
- Genomic Facility, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain;
| | | | - Alejandro Domínguez-Rodríguez
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
| | - Antonio Ordóñez
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Surgery, Faculty of Medicine, University of Seville, 41009 Sevilla, Spain
| | - Tarik Smani
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Medical Physiology and Biophysics, Faculty of Medicine, University of Seville, 41009 Seville, Spain
| |
Collapse
|
4
|
Baron Esquivias G, Morillo CM, Moya AM, Martinez Alday JD, Ruiz-Granell R, Lacunza JD, Garcia-Civera R, Gutierrez-Carretero E, Romero-Garrido R. 2167Impact of dual-chamber pacing with closed loop stimulation on quality of life in patients with recurrent reflex vasovagal syncope: results from the SPAIN study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Reflex vasovagal syncope (VVS) is one of the most common causes of syncope and, when recurrent, can have devastating consequences on the quality of life of patients despite pharmacological interventions. The closed loop stimulation (CLS) pacing algorithm converts, during an incipient VVS, variations in right intracardiac impedance into heart rate adaptation. The study SPAIN was the first randomized, double-blind trial robustly showing a strong reduction in syncopal recurrence in patients paced with dual-chamber (DDD)-CLS. (NCT01621464).
Purpose
To evaluate whether the differences observed in the SPAIN study regarding syncope burden and time to recurrence translate into improvements on quality of life.
Methods
This study analysed quality of life data from the SPAIN study: a randomized, prospective, double-blind, multicenter trial conducted in 10 Spanish and 1 Canadian centers. Ethics Committee approval was obtained at each participating center. Patients aged ≥40 years, with ≥5 VVS episodes and cardioinhibitory response to head-up tilt testing were included. After implant, patients were randomized 1:1 to active DDD-CLS mode for 12 months followed by sham DDI mode for the remaining 12 months or vice-versa. Quality of life was assessed via the Short Form-36 (SF-36) health survey before randomization (baseline), and at 12- and 24-month follow-up. The change in quality of life during the entire follow-up relative to baseline was compared between each pacing mode (DDD-CLS vs. DDI).
Results
Fifty-four patients were enrolled with a mean age of 56.3±10.6 years and a median of 12 syncopal episodes before randomization. Median SF-36 scores greatly increased from baseline in the DDD-CLS group across the 8 domains, whereas the response was variable in the DDI group. Comparing both pacing algorithms, median SF-36 scores were higher in the DDD-CLS group, with differences reaching statistical significance for “physical role” and “vitality” domains (p-value =0.006 and 0.014, respectively). Pacing sequence or treatment period did not significantly influence the response (p-value >0.05 for all the domains).
Conclusions
We demonstrated the beneficial effect of this physiological pacing algorithm on the quality of life of patients, as evidenced by the improvement in all the domains of the SF-36 when stimulated in DDD-CLS as compared to the sham DDI mode.
Collapse
Affiliation(s)
| | - C M Morillo
- Libin Cardiovascular Institute of Alberta, Cardiology, Calgary, Canada
| | - A M Moya
- Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | - R Ruiz-Granell
- University General Hospital of Valencia, Cardiology, Valencia, Spain
| | - J D Lacunza
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | - R Garcia-Civera
- University General Hospital of Valencia, Cardiology, Valencia, Spain
| | | | - R Romero-Garrido
- University Hospital Nuestra Señora de Candelaria, Cardiology, Santa Cruz de Tenerife, Spain
| |
Collapse
|
5
|
Jauregui Garrido B, Arana-Rueda E, Frutos-Lopez M, Acosta-Martinez J, Garcia-Riesco L, Gutierrez-Carretero E, De Alarcon-Gonzalez A. 58Implantable cardiac defibrillator infection is associated with repeated procedures on the generator pocket. Europace 2017. [DOI: 10.1093/ehjci/eux133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|