1
|
Chen EW, Bashir Z, Churchill JL, Has P, Klas B, Aurigemma GP, Bisaillon J, Dickey JB, Haines P. Evaluating left atrial strain and left ventricular diastolic strain rate as markers for diastolic dysfunction in patients with mitral annular calcification. Int J Cardiovasc Imaging 2024; 40:733-743. [PMID: 38289428 PMCID: PMC11052839 DOI: 10.1007/s10554-023-03041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) poses many challenges to the evaluation of diastolic function using standard echocardiography. Left atrial (LA) strain and left ventricular early diastolic strain rate (DSr) measured by speckle-tracking echocardiography (STE) are emerging techniques in the noninvasive evaluation of diastolic function. We aim to evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC and compare their effectiveness to ratio of mitral inflow velocity in early and late diastole (E/A). METHODS We included adult patients with MAC who presented between January 1 and December 31, 2014 and received a transthoracic echocardiogram (TTE) and cardiac catheterization with measurement of LVFP within a 24-h period. We used Spearman's rank correlation coefficient to assess associations of LA reservoir strain and average early DSr with LVFP. Receiver operating characteristic (ROC) curves were computed to assess the effectiveness of LA strain and DSr in discriminating elevated LVFP as a dichotomized variable and to compare their effectiveness with E/A ratio categorized according to grade of diastolic dysfunction. RESULTS Fifty-five patients were included. LA reservoir strain demonstrated poor correlation with LVFP (Spearman's rho = 0.03, p = 0.81) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.54, 95% CI 0.38-0.69). Categorical E/A ratio alone also demonstrated poor discriminatory ability (AUC = 0.53, 95% CI 0.39-0.67), and addition of LA reservoir strain did not significantly improve effectiveness (AUC = 0.58, 95% CI 0.42-0.74, p = 0.56). Average early DSr also demonstrated poor correlation with LVFP (Spearman's rho = -0.19, p = 0.16) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.59, 95% CI 0.44-0.75). Addition of average early DSr to categorical E/A ratio failed to improve effectiveness (AUC = 0.62, 95% CI 0.46-0.77 vs. AUC = 0.54, 95% CI 0.39-0.69, p = 0.38). CONCLUSIONS In our sample, LA reservoir strain and DSr do not accurately predict diastolic filling pressure. Further research is required before LA strain and early DSr can be routinely used in clinical practice to assess filling pressure in patients with MAC.
Collapse
Affiliation(s)
- Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zubair Bashir
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica L Churchill
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, RI, USA
| | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Jonathan Bisaillon
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Philip Haines
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
2
|
Bashir Z, Chen EW, Wang S, Shu L, Goldstein ED, Rana M, Kala N, Dai X, Mandel D, Has P, Xie M, Wang T, Dickey JB, Poppas A, Simmons J, Song C, Yaghi S, Haines P. Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection. Echocardiography 2024; 41:e15738. [PMID: 38284672 DOI: 10.1111/echo.15738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Atrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS. METHODS The study population included patients with ESUS and noncardioembolic (NCE) stroke presenting to the Rhode Island Hospital Stroke Center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the three phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow-up detection of AF in ESUS patients. RESULTS We identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266-2.986, p = .002), contractile (aOR 1.568, 95% CI 1.035-2.374, p = .034), and conduit strain (aOR 2.288, 95% CI 1.448-3.613, p = .001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029-6.236, p = .043), contractile strain (OR 2.828, 95% CI 1.158-6.903, p = .022), and conduit strain (OR 2.614, 95% CI 1.003-6.815, p = .049) were significantly associated with subsequent detection of AF. CONCLUSION Reduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.
Collapse
Affiliation(s)
- Zubair Bashir
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shuyuan Wang
- Department of Ultrasound, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqi Shu
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric D Goldstein
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Maheen Rana
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Narendra Kala
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xing Dai
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Mandel
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Mingxing Xie
- Department of Ultrasound, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, California, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcestor, Massachusetts, USA
| | - Athena Poppas
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Simmons
- Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher Song
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Philip Haines
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
3
|
Aurigemma GP, Gentile BA, Dickey JB, Fitzgibbons TP, Tighe DA, Kakouros N, Kovell LC, Gottbrecht MF, Narvaez-Guerra O, Qureshi W, Gerson DS, Parker MW. Insights Into the Standard Echocardiographic Views From Multimodality Imaging: Ventricles, Pericardium, Valves, and Atria. J Am Soc Echocardiogr 2023; 36:1266-1289. [PMID: 37549797 DOI: 10.1016/j.echo.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax. In addition to reviewing basic cardiac anatomy, the authors take advantage of these correlations with computed tomography and cardiac magnetic resonance imaging to better understand the issue of foreshortening, a common pitfall in transthoracic echocardiography. The authors also highlight an important role that three-dimensional echocardiography can potentially play in the future, especially as advances in image processing permit higher fidelity multiplanar reconstruction images.
Collapse
Affiliation(s)
- Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts.
| | - Bryon A Gentile
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Timothy P Fitzgibbons
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Dennis A Tighe
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Matthew F Gottbrecht
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Offdan Narvaez-Guerra
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Waqas Qureshi
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - David S Gerson
- Department of Radiology, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Matthew W Parker
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| |
Collapse
|
4
|
Bashir Z, Chen EW, Tori K, Ghosalkar D, Aurigemma GP, Dickey JB, Haines P. Insight into different phenotypic presentations of heart failure with preserved ejection fraction. Prog Cardiovasc Dis 2023; 79:80-88. [PMID: 37442358 DOI: 10.1016/j.pcad.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for half of all HF diagnoses, and its prevalence is increasing at an alarming rate. Lately, it has been recognized as a clinical syndrome due to diverse underlying etiology and pathophysiological mechanisms. The classic echocardiographic features of HFpEF have been well described as preserved ejection fraction (≥50%), left ventricular hypertrophy, and left atrial enlargement. However, echocardiography can play a key role in identifying the principal underlying mechanism responsible for HFpEF in the individual patient. The recognition of different phenotypic presentations of HFpEF (infiltrative, metabolic, genetic, and inflammatory) can assist the clinician in tailoring the appropriate management, and offer prognostic information. The goal of this review is to highlight several key phenotypes of HFpEF and illustrate the classic clinical scenario and echocardiographic features of each phenotype with real patient cases.
Collapse
Affiliation(s)
- Zubair Bashir
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Edward W Chen
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Dhairyasheel Ghosalkar
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Hospital, NY, USA
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Philip Haines
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
5
|
Dickey JB, Albert E, Badr M, Laraja KM, Sena LM, Gerson DS, Saucedo JE, Qureshi W, Aurigemma GP. A Series of Patients With Myocarditis Following SARS-CoV-2 Vaccination With mRNA-1279 and BNT162b2. JACC Cardiovasc Imaging 2021; 14:1862-1863. [PMID: 34246585 PMCID: PMC8219373 DOI: 10.1016/j.jcmg.2021.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
|
6
|
Parker MW, Muchnik RD, Ogunsua A, Kundu A, Lakshmanan S, Shah N, Dickey JB, Gentile BA, Pape LA. Serial echocardiography for valve dysfunction and aortic dilation in bicuspid aortic valves. Echocardiography 2021; 38:394-401. [PMID: 33586263 DOI: 10.1111/echo.15000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Complications of bicuspid aortic valve commonly include aortic stenosis, aortic regurgitation, and ascending aortic dilation. The progression of these lesions is not well described. MATERIALS AND METHODS We reviewed 249 bicuspid aortic valve patients with at least two echocardiograms from 2006 to 2016. Valve morphology (right-left or right-noncoronary cusp fusion) was confirmed by visual inspection, and aortic stenosis and regurgitation were quantified according to current guidelines; the ascending aorta was measured at end-systole 2-3 cm above the sinotubular junction. Annualized progression of stenosis, regurgitation, and aortic dilation from first to most recent echocardiogram were compared between right-left and right-nonfused valves using multivariable logistic regression to adjust for baseline differences in groups. RESULTS Among 249 bicuspid aortic valve patients (mean age 47.6 ± 13.5 years, 66.3% male), 75.9% had right-left cusp fusion. At baseline, aortic stenosis was absent or mild in 80.3%; aortic regurgitation was absent or mild in 80.7%; and aortic diameters were 35.0 ± 5.7 mm (sinuses of Valsalva) and 37.4 ± 6.2 mm (ascending). Mean annualized decrease in aortic valve area was 0.07 cm2 /year, with 30% of bicuspid aortic valve patients progressing ≥0.1 cm2 /year. Aortic regurgitation progressed ≥1 grade in 37 patients. Mean annualized increase in ascending aorta diameter was 0.36 mm/year in right-left and 0.65 mm/year in right-nonbicuspid valves. CONCLUSIONS In this serial echocardiographic study of bicuspid aortic valve patients, cusp orientation was not associated with progression of valve dysfunction. Right-noncoronary cusp fusion was associated with ascending aortic diameter progression.
Collapse
Affiliation(s)
- Matthew W Parker
- Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Renee Dallasen Muchnik
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Adedotun Ogunsua
- Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Amartya Kundu
- Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA
| | | | - Nikhil Shah
- Division of Cardiovascular Medicine, University of Florida Health, Gainesville, FL, USA
| | - John B Dickey
- Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Bryon A Gentile
- Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Linda A Pape
- Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA
| |
Collapse
|
7
|
Haines PG, Dickey JB, Chambers AB, Ogunsua A, Wu W, Aurigemma GP. Evaluating a decision tool for diagnosing diastolic dysfunction and estimation of left ventricular filling pressures in the presence of mitral annular calcium. Echocardiography 2020; 37:1757-1765. [DOI: 10.1111/echo.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Philip G. Haines
- Division of Cardiology Department of Medicine Warren Alpert School of Medicine of Brown University Providence RI USA
| | - John B. Dickey
- Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA
| | - Alison B. Chambers
- Department of Medicine Rhode Island Hospital Warren Alpert School of Medicine of Brown University Providence RI USA
- Lifespan Biostatistics Core Rhode Island Hospital Providence RI USA
| | - Adedotun Ogunsua
- Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA
| | - Wen‐Chih Wu
- Division of Cardiology Department of Medicine Warren Alpert School of Medicine of Brown University Providence RI USA
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA
| |
Collapse
|
8
|
Abstract
We cultured anterior chamber aspirates of 28 patients who had uncomplicated cataract surgery. Fourteen patients had received 80 micrograms/ml of gentamicin in balanced salt solution through irrigation of the anterior chamber throughout cataract extraction, and 14 patients had received 8 micrograms/ml of gentamicin. Cultures of anterior chamber fluid obtained at the end of surgery from all 28 patients had no growth on two nonselective media. There was no clinical evidence of ocular toxicity. This study demonstrates that antibiotic in the intraocular irrigation fluid can reduce or eliminate the expected intraocular bacterial load after cataract surgery.
Collapse
Affiliation(s)
- J B Dickey
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153
| | | | | |
Collapse
|
9
|
Abstract
FK-506 is a new immunosuppressant with the ability to inhibit activation of T-lymphocytes that would be cytolytic to an allograft. We studied periocular injection of FK-506 in a rat penetrating keratoplasty model. Corneas were transplanted from Brown Norway rats into Lewis rat recipients. The transplanted rats received periocular injection of either 0.5 mg/kg FK-506 or an equivalent volume of FK-506 vehicle only. Injections were given 1 day before, at keratoplasty, and every other day after keratoplasty until allograft rejection. The group receiving FK-506 had a significant delay in allograft rejection (p < 0.05). The FK-506 group rejected 12-20 days postkeratoplasty with a mean rejection time (MRT) of 14.3 days, compared with 8-14 days (MRT 11.1 days) for the control group. We conclude that periocular administration of FK-506 is effective in prolonging allograft survival in the rat penetrating keratoplasty model.
Collapse
Affiliation(s)
- J B Dickey
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153
| | | | | |
Collapse
|
10
|
Abstract
In three patients with transient cataracts the lenticular opacities were feathery in nature, and posterior subcapsular in location. They appeared to emanate from a dense central posterior subcapsular plaque. These opacities were examined with the slit lamp and documented photographically. The onset of cataract was abrupt in all three patients, and resolved over a three- to 36-day period. Two patients had bilateral reversible cataracts, and in one of these patients the lenticular opacities were recurrent. Two of the patients had been taking oral corticosteroids. Temporary cataracts have been previously reported in patients with poor diabetic control. Diabetes mellitus had been diagnosed in only one of our patients. Three-hour glucose tolerance testing of the other two patients disclosed mildly increased one-hour blood glucose levels. We believe that reversible lens opacities may occur in subclinical diabetes mellitus with normal or only mildly increased blood glucose levels.
Collapse
Affiliation(s)
- J B Dickey
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153
| | | |
Collapse
|
11
|
Abstract
Cholesterol granuloma of the orbit is an uncommon entity, although it frequently occurs in the middle ear and petrous apex. It is isodense with brain on computed tomographic scanning and cannot always be differentiated from more serious conditions. Magnetic resonance imaging (MRI) has facilitated the preoperative diagnosis of cholesterol granuloma outside of the orbit because of high signal characteristics on T1- and T2-weighted images. These findings have been considered nearly pathognomonic, but they have previously been described in only one patient with orbitofrontal involvement. We present a case of orbitofrontal cholesterol granuloma with uncharacteristic signal intensities on magnetic resonance imaging.
Collapse
Affiliation(s)
- J B Dickey
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153
| | | | | |
Collapse
|
12
|
|
13
|
Abstract
We cultured anterior chamber aspirates of 30 patients who had uncomplicated extracapsular cataract extraction or phacoemulsification. The aspirate was obtained at the time of wound closure. Of 30 patients, 13 (43%) had culture-positive anterior chamber aspirates. The total number of organisms recovered was 18, with three patients having multiple organisms identified. The most commonly isolated organisms were coagulase-negative Staphylococcus sp., occurring in eight of 18 isolates (44%). No eyes in our study developed endophthalmitis, even though almost one half had viable organisms growing from the anterior chamber aspirates. Inoculum sizes were extremely small (10 to 20 colony-forming units/ml). This study suggests that in humans, the anterior chamber is capable of clearing a low inoculum of bacteria after cataract surgery without the development of endophthalmitis.
Collapse
Affiliation(s)
- J B Dickey
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL 60153
| | | | | |
Collapse
|
14
|
Abstract
Propofol is an intravenous anesthetic agent that was approved by the US Food and Drug Administration in October 1989. It has gained rapid acceptance and is in widespread use. In June 1990, the Centers for Disease Control reported four clusters of postsurgical infections associated with the use of propofol. We describe one of those clusters, consisting of four cases of endogenous Candida albicans endophthalmitis. These infections occurred in nonimmunocompromised patients after they had undergone nonophthalmologic surgery in which propofol had been used as anesthesia. An investigation by the Centers for Disease Control concluded that the infections in these patients were due to extrinsic contamination of propofol during preparation for use at the hospital. Ophthalmologists should be aware of this new potential source of endogenous endophthalmitis.
Collapse
Affiliation(s)
- M J Daily
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL 60153
| | | | | |
Collapse
|