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Bohbot Y, Habib G, Stohr E, Chirouze C, Hernandez-Meneses M, Melissopoulou M, Scheggi V, Branco L, Olmos C, Reye G, Pazdernik M, Iung B, Sow R, Lancellotti P, Tribouilloy C. Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) regist. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1663] [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: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Congestive heart failure (CHF) is a strong prognostic factor in infective endocarditis (IE), but data are lacking regarding its current management and outcome in Europe.
Purpose
To evaluate the current management and survival of patients with left-sided IE complicated by CHF.
Methods
We used data of the ESC-EORP EURO-ENDO registry, which is a prospective multicentre observational study conducted between January 1, 2016 and March 31, 2018 in 156 centres in 40 countries. The primary endpoints were 30-day and one-year mortality.
Results
Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n=698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p≤0.019). Patients with CHF experienced higher 30-day and one-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (OR [95% CI]: 2.37 [1.73–3.24]; p<0.001) and one-year mortality (HR [95% CI]: 1.69 [1.40–2.05]; p<0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n=618 [88.5%] for each group, both p<0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson index, cerebrovascular accident, staphylococcus aureus IE, Streptococcal IE, uncontrolled infection, vegetation size >10mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR [95% CI]: 0.22 [0.12–0.38]; p<0.001) and in one-year mortality (HR [95% CI]: 0.29 [0.20–0.41]; p<0.001).
Conclusion
CHF is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and one-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular Int. (2011–2014) Amgen Cardiovascular (2009–2018),
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Affiliation(s)
- Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - G Habib
- Hospital La Timone of Marseille , Marseille , France
| | - E Stohr
- University hospital Bonn , Bonn , Germany
| | - C Chirouze
- University of Besançon , Besancon , France
| | | | | | - V Scheggi
- University of Florence , Florence , Italy
| | - L Branco
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre , Lisbon , Portugal
| | - C Olmos
- Hospital Clinico San Carlos , Madrid , Spain
| | - G Reye
- Instituto Medico de Alta Complejidad (IMAC) , Buenos Aires , Argentina
| | - M Pazdernik
- Charles University of Prague , Prague , Czechia
| | - B Iung
- Bichat APHP Site of Paris Nord University Hospital , Paris , France
| | - R Sow
- Hospital Center of Luxembourg , Luxembourg , Luxembourg
| | - P Lancellotti
- University Hospital of Liege (CHU) , Liege , Belgium
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2
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Sundermeyer J, Beer BN, Blankenberg S, Kirchhof P, Luedike P, Mangner N, Nordbeck P, Orban M, Pazdernik M, Proudfoot A, Schulze PC, Tavazzi G, Thiele H, Westermann D, Schrage B. Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1013] [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: 11/14/2022] Open
Abstract
Abstract
Background
Evidence in non-ischaemic cardiogenic shock (CS), especially regarding prognostic markers and use of mechanical circulatory support (MCS), is scarce.
Aim
The aim of this study was to evaluate left ventricular ejection fraction (LVEF) as a prognostic marker as well as a factor to guide the use of MCS in non-ischaemic CS.
Methods
In this international observational study, patients with non-ischaemic CS (e.g. caused by severe de-novo or acute on chronic heart failure; but not by acute myocardial infarction) treated with or without MCS from 18 tertiary-care centers in five countries were enrolled. Cox regression models adjusted for age, sex, SCAI class, lactate, prior resuscitation, mechanical ventilation and pH were fitted to evaluate the association between LVEF and 30-day mortality as well as the interaction between MCS use, LVEF and 30-day mortality.
Results
A total of 807 patients were enrolled, of whom 387 (47,9%) were treated with and 418 (52.1%) without MCS; mean age was 63 [interquartile range (IQR) 51.5–72) years, 601 (74.5%) were male, 486 (60.2%) had acute on chronic heart failure, 221 (32.7%) had an ischaemic cardiomyopathy and 277 (34.5%) had prior cardiac arrest. The baseline LVEF was 20 (IQR 15–30) % and baseline lactate was 4.9 (IQR 2.6–8.5) mmol/l.
There was no significant association between LVEF and 30-day mortality risk [hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.74–1.22 if LVEF was considered as a continuous variable; HR 1.09, 95% CI 0.83–1.44 if LVEF was considered as a categorical variable with ≤20% vs. >20%]. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with a depressed LVEF (HR 0.74, 95% CI 0.52–1.05, interaction-p = 0.04).
Conclusion
In this retrospective, multicenter, international study of patients with non-ischaemic CS, LVEF was not a predictor of 30-day mortality risk. However, we observed a significant interaction between MCS use and LVEF, indicating a lower morality risk with MCS use only in patients with a depressed LVEF. This provides rationale to use LVEF as a parameter to guide MCS therapy in non-ischaemic CS, and calls for a randomized trial on this topic.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sundermeyer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - B N Beer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Luedike
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - N Mangner
- Heart Centre Dresden - Dresden Technical University Hospital , Dresden , Germany
| | - P Nordbeck
- University Hospital of Wurzburg, Department of Internal Medicine I, , Würzburg , Germany
| | - M Orban
- University Hospital of Munich , Munich , Germany
| | - M Pazdernik
- Institute for Clinical and Experimental Medicine , Prague , Czechia
| | - A Proudfoot
- St Bartholomew's Hospital , London , United Kingdom
| | | | - G Tavazzi
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
| | - B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
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Pazdernik M, Holicka M, Pelouch R, Precek J, Widimsky J, Pudich J, Vancata R, Siranec M, Bohm A, Blechova K, Butta T, Mikulcova M, Mikulica M, Wohlfahrt P. Characteristics, management, and outcome of infective endocarditis in the Czech Republic: prospective data from the ESC EORP EURO-ENDO registry. ACTA ACUST UNITED AC 2021; 122:95-100. [PMID: 33502876 DOI: 10.4149/bll_2021_014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Data describing contemporary profile of infective endocarditis (IE) in the Czech Republic are lacking. The aim of this study was to describe the current profile and outcomes of IE patients. METHODS Prospectively collected data on consecutive patients admitted for IE diagnosis between April 2016 and March 2018 to 11 main tertiary care cardiac centers in the Czech Republic were used for this analysis. RESULTS Among 208 patients, 88 patients (42.3 %) had native valve IE (NVIE), 56 patients (26.9 %) had prosthetic valve IE (PVIE), and 57 patients (27.4 %) had intracardiac device-related IE (CDRIE). The mean age was 61.66±15.54 years. Staphylococcus aureus was the most common etiological agent of IE (27.4 %), whereas Culture negative IE was present in 26.4 % patients. Surgery was performed during hospitalization in 112 (53.8 %) patients. In-hospital death occurred in 21.2 % patients, while 1-year mortality was 40.3 %. In patients, who had an indication for surgery, but the procedure was not performed, mortality was significantly higher (p=0.002). CONCLUSION High proportion of culture negative IE and IE related to artificial intra-cardiac materials calls for action. Furthermore, we show that cardiac surgery should be more often contemplated, especially in the presence of risk factors as septic shock and congestive heart failure (Tab. 6, Fig. 1, Ref. 32).
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Pazdernik M, Selton-Suty C, Lancellotti P, Kong W, Srdanovic I, Yamada H, Riezebos R, De Martino A, Pierard L, Nunes M, Haertel Miglioranza M, Magne J, Mutlu B, Habib G, Iung B. Age-related characteristics of infective endocarditis: prospective data from the Euro-Endo registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2032] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The profile of infective endocarditis (IE) is continuously evolving over time, and this may probably be partly due to increasing age of the patients.
Methods
All data were collected from the EURO-ENDO registry, which is a one-year prospective international multicentre observational survey on patients with definite or possible IE included between 2016 and 2018. Subjects were stratified into 3 groups according to their age at index hospitalization.
Results
Among the 3113 patients included, 1670 patients (54%, Young group) were <65, 1068 (34%, Medium group) between 65 and 80 and 375 (12%, Old group) ≥80 years old. The most striking age-related differences were (old group vs others) (table 1) 1) the higher comorbidity burden and Charlson index; 2) the lower rate of embolic events on admission and under therapy; 3) the higher rate of Enterocci and digestive streptococci; 4) the lower rate of surgery during acute IE despite a theoretical indication; 5) the higher in-hospital and 1-year mortality. With regards to surgery, young and medium age were predictive of more frequent performance of surgery as compared to old age (Young: OR 4.33, 95% CI [3.09–6.06], Medium: 3.62, [2.57–5.10], p<0.001). In multivariable analysis, age per se was not predictive of in-hospital and 1yr FU mortality, but lack of surgical procedures when indicated (27% of the old group), was strongly predictive.
Conclusion
This is the largest contemporary registry showing the strong influence of age on the demographic, clinical, therapeutic, and prognostic profile of IE. Non-performance of surgical procedures when indicated is frequent in old patients and is a strong predictor of mortality while age per se is not. Endocarditis Teams should take these results into account when considering surgery in elderly patients.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): EORP grant
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Affiliation(s)
- M Pazdernik
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - C Selton-Suty
- CHU Nancy-Brabois, University Hospital of Nancy-Brabois, Nancy, France
| | | | - W.K.F Kong
- National Heart Centre Singapore, Singapore, Singapore
| | - I Srdanovic
- Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
| | - H Yamada
- Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - R.K Riezebos
- Heart center, OLVG, Amsterdam, Netherlands (The)
| | | | - L Pierard
- University Hospital Sart Tilman, Liege, Belgium
| | - M Nunes
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - J Magne
- Dupuytren University Hospital Centre Limoges, Limoges, France
| | - B Mutlu
- Marmara University Hospital, Pendik, Istanbul, Turkey
| | - G Habib
- APHM, La Timone Hospital, Marseille, France
| | - B Iung
- Bichat Hospital, APHP, Universite' de Paris, Paris, France
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5
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Pazdernik M, Hubacek J, Wohlfahrt P, Kautzner J, Melenovsky V, Stiavnicky P, Carna Z, Karmazin V, Kovarnik T, Bedanova H, Wahle A, Chen Z, Sonka M. Role of Genetics in Development of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1293] [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: 11/30/2022] Open
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Pazdernik M, Wichterle D, Chen Z, Zhang H, Wahle A, Kautzner J, Melenovsky V, Malek I, Karmazin V, Bedanova H, Ozabalova E, Tomasek A, Kovarnik T, Sonka M. Effect of Heart Rate on Early Progression of Cardiac Allograft Vasculopathy: A Prospective Study Using Highly Automated 3-D Optical Coherence Tomography Analysis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.708] [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: 11/25/2022] Open
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7
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Mullan S, Chen Z, Pazdernik M, Zhang H, Wahle A, Melenovsky V, Kautzner J, Karmazin V, Bedanova H, Tomasek A, Ozabalova E, Sonka M. Deep Learning Facilitates Automation of Wall Layer Quantification in Heart Transplant Coronary OCT. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Pazdernik M, Wohlfahrt P, Kautzner J, Kettner J, Sochman J, Stasek J, Solar M, Pelouch R, Vojacek J. Clinical predictors of complications in patients with left–sided infective endocarditis: A retrospective study of 206 episodes. ACTA ACUST UNITED AC 2019; 120:510-515. [DOI: 10.4149/bll_2019_082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Melenovsky V, Kovar J, Pazdernik M, Hoskova L, Vrablik M, Franekova J, Kautzner J. P2805Elevated PCSK9 levels may contribute to dyslipidemia early after cardiac trasplantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2805] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Melenovsky
- Institute for clinical and experimental medicine, Prague, Czech Republic
| | - J Kovar
- Institute for clinical and experimental medicine, Prague, Czech Republic
| | - M Pazdernik
- Institute for clinical and experimental medicine, Prague, Czech Republic
| | - L Hoskova
- Institute for clinical and experimental medicine, Prague, Czech Republic
| | - M Vrablik
- Charles University of Prague, 1st Faculty of Medicine, 3rd Department of Medicine, Prague, Czech Republic
| | - J Franekova
- Institute for clinical and experimental medicine, Prague, Czech Republic
| | - J Kautzner
- Institute for clinical and experimental medicine, Prague, Czech Republic
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Pazdernik M, Chen Z, Bedanova H, Kautzner J, Melenovsky V, Karmazin V, Malek I, Tomasek A, Ozabalova E, Krejci J, Franekova J, Wahle A, Zhang H, Kovarnik T, Sonka M. Detecting Early Cardiac Allograft Vasculopathy Using Highly Automated 3D Coronary Optical Coherence Tomography Segmentation Analysis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Pazdernik M, Kovarnik T, Chen Z, Wahle A, Karmazin V, Melenovsky V, Kautzner J, Tomasek A, Bedanova H, Sonka M. Increased Heart Rate After Heart Transplant Is Not Associated with Early Progression of Cardiac Allograft Vasculopathy (CAV) - A Prospective Study Using Highly Automatic Coronary Optical Coherence Tomography Segmentation Software in 3D. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1467] [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: 10/19/2022] Open
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12
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Pazdernik M, Kovarnik T, Sonka M, Wahle A, Chen Z, Karmazin V, Kautzner J, Tomasek A, Melenovsky V, Bedanova H. Should We Pharmacologically Modulate Renin-Aldosterone-Angiotensin System (RAAS) to Attenuate Cardiac Allograft Vasculopathy? A Prospective Study Using Highly Automated Coronary Optical Coherence Tomography Segmentation Software in 3D. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1451] [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: 10/19/2022] Open
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13
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Pazdernik M, Malek I, Melenovsky V, Maxian R, Binova J, Franekova J, Jabor A, Karmazin V, Hegarova M, Kautzner J. Cardiac Allograft Vasculopathy Assessed By Quantitative Coronary Angiography: A Single Center Prospective Study. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.836] [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: 10/23/2022] Open
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Correa de Sa D, Tleyjeh I, Schultz J, Thomas J, Bachuwar A, Pazdernik M, Anavekar N, Steckleberg J, Wilson W, Baddour L. 004 RECENT TRENDS IN THE EPIDEMIOLOGY OF INFECTIVE ENDOCARDITIS: A POPULATION-BASED STUDY IN OLMSTED COUNTY, MINNESOTA. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70023-8] [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: 10/20/2022]
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