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Hassan AY, Kassem HH, Kandil HI, Meshaal MS, Salem MA, Mohamed AS. Impact of Cardiac Computed Tomographic Angiography on Diagnostic and Therapeutic Decisions in Patients with Suspected Prosthetic Heart Valve Dysfunction. J Saudi Heart Assoc 2021; 33:85-94. [PMID: 33936942 PMCID: PMC8084306 DOI: 10.37616/2212-5043.1231] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Computed Tomography (CT) scan is a helpful tool to assess the coronary arteries and the great vessels. However, its routine use in the assessment of patients with suspected prosthetic valve dysfunction (PVD) has not been studied thoroughly. Objective To determine the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD. Methods and results This was a prospective cohort study that was conducted on 50 consecutive patients with suspected PVD who underwent both 64-slice ECG-gated CT and transesophageal echocardiography (TEE). The gold standard was the intraoperative findings. Surgery was performed in forty-six patients. ECG-gated CT showed findings that were not detected by TEE in sixteen patients (32%) namely aortic root abscess, aortic pseudoaneurysm, paravalvular leakage (PVL), sclero-calcific disruption of sutures as cause of PVL, mechanical prosthesis occluder malfunction, an underlying thrombus as cause of malfunction and finally presence of aortic dissection. Furthermore, CTA findings dictated treatment changes in fourteen patients (28%). Conclusion This study demonstrates that ECG-gated CTA has a complementary role to TEE in patients with suspected PVD. CCTA is more accurate in diagnosis of periannular complications (Aortic root abscess and Pseudo-aneurysm) and in delineating their anatomical relation to surrounding cardiac structures. Therefore CCTA can have important role in deciding and planning the method of correction whether surgical or percutaneous and has to be considered after TEE in patients with a high suspicion on PVD.
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Elamragy AA, Meshaal MS, El-Kholy AA, Rizk HH. Gender differences in clinical features and complications of infective endocarditis: 11-year experience of a single institute in Egypt. Egypt Heart J 2020; 72:5. [PMID: 31965410 PMCID: PMC6974112 DOI: 10.1186/s43044-020-0039-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/22/2019] [Accepted: 01/12/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND No data exists about the gender differences among patients with infective endocarditis (IE) in Egypt. The objective was to study possible gender differences in clinical profiles and outcomes of patients in the IE registry of a tertiary care center over 11 years. RESULTS The IE registry included 398 patients with a median age of 30 years (interquartile range, 15 years); 61.1% were males. Males were significantly older than females. Malignancy and recent culprit procedures were more common in females while chronic liver disease and intravenous drug abuse (IVDU) were more in males. IE on top of structurally normal hearts was significantly more in males (25.6% vs 13.6%, p = 0.005) while rheumatic valvular disease was more common in females (46.3% vs 29.9%, p = 0.001). There was no difference in the duration of illness before presentation to our institution. The overall complication rate was high but significantly higher in females. However, there were no significant differences in the major complications: mortality, fulminant sepsis, renal failure requiring dialysis, heart failure class III-IV, or major cerebrovascular emboli. CONCLUSION In this registry, IE occurred predominantly in males. Females were significantly younger at presentation. History of recent culprit procedures was more common in females while IVDU was more common in males who had a higher incidence of IE on structurally normal hearts. The overall complication rate was higher in women. IE management and its outcomes were similar in both genders.
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Affiliation(s)
- Ahmed Adel Elamragy
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Marwa Sayed Meshaal
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Amani Ali El-Kholy
- Department of Clinical Pathology and Microbiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hussein Hassan Rizk
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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Rizk HH, Elamragy AA, Youssef GS, Meshaal MS, Samir A, ElSharkawy A, Said K, Kassem HH, Elanany MG, El-Kholy AA, Akl AS, Mahfouz SM, Sorour KA. Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility. Egypt Heart J 2019; 71:17. [PMID: 31659524 PMCID: PMC6821432 DOI: 10.1186/s43044-019-0018-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. RESULTS The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients' clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). CONCLUSION This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.
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Affiliation(s)
- Hussein Hassan Rizk
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmed Adel Elamragy
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ghada Sayed Youssef
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Marwa Sayed Meshaal
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmad Samir
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmed ElSharkawy
- Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Karim Said
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Hussien Heshmat Kassem
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Mervat Gaber Elanany
- Department of Clinical Pathology and Microbiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Amani Ali El-Kholy
- Department of Clinical Pathology and Microbiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Al Sayed Akl
- Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Soheir M. Mahfouz
- Department of Pathology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Khaled Ali Sorour
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
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Meshaal MS, Labib D, Said K, Hosny M, Hassan M, Abd Al Aziz S, Elkholy A, Anani M, Rizk H. Correction: Aspergillus endocarditis: Diagnostic criteria and predictors of outcome, A retrospective cohort study. PLoS One 2018; 13:e0208350. [PMID: 30481217 PMCID: PMC6258554 DOI: 10.1371/journal.pone.0208350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Meshaal MS, Labib D, Said K, Hosny M, Hassan M, Abd Al Aziz S, Elkholy A, Anani M, Rizk H. Correction: Aspergillus endocarditis: Diagnostic criteria and predictors of outcome, A retrospective cohort study. PLoS One 2018; 13:e0203103. [PMID: 30138467 PMCID: PMC6107235 DOI: 10.1371/journal.pone.0203103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0201459.].
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Meshaal MS, Labib D, Said K, Hosny M, Hassan M, Abd Al Aziz S, Elkholy A, Anani M, Rizk H. Aspergillus endocarditis: Diagnostic criteria and predictors of outcome, A retrospective cohort study. PLoS One 2018; 13:e0201459. [PMID: 30092074 PMCID: PMC6084895 DOI: 10.1371/journal.pone.0201459] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/15/2018] [Indexed: 01/04/2023] Open
Abstract
Background Fungal Endocarditis (FE), a relatively rare disease, has a high rate of mortality and is associated with multiple morbidities. Aspergillus endocarditis (AE) is severe form of FE. Incidence of AE has increased and is expected to rise due to an increased frequency of invasive procedures, cardiac devices and prosthetic valves together with increased use of immune system suppressors. AE lacks most of the clinical criteria used to diagnose infective endocarditis (IE), where blood culture is almost always negative, and fever may be absent. Diagnosis is usually late and in many cases is made post-mortem. Late or mistaken diagnosis of AE contribute to delayed and incorrect management of patients. In the current study we aimed to describe the clinical, laboratory and imaging characteristics of AE, to identify predictors of early diagnosis of this serious infection. Methods Patients with definite/possible IE, as diagnosed by the Kasr Al-Ainy IE Working Group from February 2005 through June 2016, were reviewed in this study. We compared the demographic, clinical, laboratory and imaging criteria of AE patients to non-fungal IE patients. Results This study included 374 patients with IE in which FE accounted for 43 cases. Aspergillus was the most common fungus (31 patients; 8.3%) in the patient group. Lack of fever and acute limb ischemia at presentation were significantly associated with AE (p < 0.001, p = 0.014, respectively). Health care associated endocarditis (HAE) and prosthetic valve endocarditis (PVE) were the only significant risk factors associated with AE (p < 0.001 for each). Mitral, non-valvular, and aortotomy site vegetations, as well as aortic abscess/pseudoaneurysm, were significantly associated with AE (p = 0.022, p = 0.004, p < 0.001, and p < 0.001, respectively). Through multivariate regression analysis, HAE, PVE, aortic abscess/pseudoaneurysm, and lack of fever were strongly linked to AE. The probability of an IE patient having AE with HAE, PVE, and aortic abscess/pseudoaneurysm, but no fever, was 0.92. In contrast, the probability of an IE patient having AE with fever, native valve IE, but no health-care associated IE and no abscess/pseudoaneurysm, was 0.003. Severe sepsis and mortality in the Aspergillus group were higher as compared to the non-fungal group (p = 0.098 and 0.097, respectively). Thirteen AE patients died during hospitalization. PVE, the use of single versus dual antifungal agents, severe heart failure, and severe sepsis were significant predictors of mortality (p = 0.008, 0.012, 0.003, and 0.01, respectively). Conclusion To our knowledge, this is the first study to address diagnostic criteria for AE. Through multivariate regression analysis, absence of fever, HAE, PVE, and aortic abscess/pseudoaneurysm were strong predictors of AE. Use of these criteria my lead to earlier diagnoses of AE. Early treatment of AE patients with voriconazole in combination with other antifungal agents may be possible based on the previously mentioned criteria, which may facilitate better patient outcomes.
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Affiliation(s)
- Marwa Sayed Meshaal
- Cardiovascular Medicine Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
- * E-mail:
| | - Dina Labib
- Cardiovascular Medicine Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Karim Said
- Cardiovascular Medicine Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Mohammed Hosny
- Cardiovascular Medicine Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Mohammed Hassan
- Cardiovascular Medicine Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Said Abd Al Aziz
- Cardiothoracic Surgery Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Amani Elkholy
- Clinical Pathology Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Mervat Anani
- Clinical Pathology Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Hussien Rizk
- Cardiovascular Medicine Department, Kasr Al-Ainy Teaching Hospital, Cairo University, Cairo, Egypt
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Meshaal MS, Kassem HH, Samir A, Zakaria A, Baghdady Y, Rizk HH. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis. PLoS One 2015; 10:e0118616. [PMID: 25823006 PMCID: PMC4379076 DOI: 10.1371/journal.pone.0118616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 01/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE. METHODS From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention. RESULTS The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture. CONCLUSIONS Routine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE.
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Affiliation(s)
| | | | - Ahmad Samir
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Ayman Zakaria
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Yasser Baghdady
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
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