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Benvenga RM, Tribouilloy C, Michelena HI, Silverio A, Arregle F, Martel H, Denev S, Bohbot Y, Hubert S, Renard S, Camoin L, Casalta AC, Casalta JP, Gouriet F, Riberi A, Lepidi H, Collart F, Raoult D, Drancourt M, Galasso G, DeSimone DC, Citro R, Habib G. Clinical and Echocardiographic Features of Patients With Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology. J Am Soc Echocardiogr 2023; 36:760-768. [PMID: 36682434 DOI: 10.1016/j.echo.2023.01.010] [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: 04/22/2022] [Revised: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The influence of different bicuspid aortic valve (BAV) morphology in the clinical course of infective endocarditis (IE) has not yet been investigated. This study aimed to describe the clinical and echocardiographic features of IE in patients with BAV (BAVIE) according to valve morphology. METHODS Patients with definite BAVIE prospectively enrolled in 4 high-volume referral centers from 2000 to 2019 were evaluated and divided into 2 groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right noncoronary or left noncoronary (non-RL type) cusp fusion. All patients were followed up for 1 year. RESULTS One hundred thirty-eight patients with BAVIE were included (77.7% male; median age, 52 [36.83-61.00] years): 112 patients with RL type (81%) and 26 patients with non-RL type BAV (19%), with no significant differences in age, sex, and comorbidities between groups. Although 43% of the cohort had known BAV, the referral was late after symptom onset, particularly for the RL phenotype; time from symptom onset to hospitalization >30 days (31.3% vs 11.5%; P = .032) and New York Heart Association class ≥ II (64.3% vs 42.3%; P = .039) were more frequent in patients with RL type BAV than in patients with non-RL type BAV. Conversely, patients with non-RL type BAV had a higher incidence of hemorrhagic stroke (19.2% vs 5.4%; P = .034) and high-grade atrioventricular block (11.5% vs 0.9%; P = .021). Streptococcus viridans was more frequently isolated in patients with non-RL type BAV than in patients with RL type BAV (44% vs 24.1%; P = .045). No difference in short- and intermediate-term mortality was observed between groups. CONCLUSIONS Clinical profile and echocardiographic features in BAVIE patients may differ according to valve morphology, and patients with BAVIE appear to be referred late, even when BAV disease is previously known.
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Affiliation(s)
- Rossella Maria Benvenga
- Cardiology Department, APHM, La Timone Hospital, Marseille, France; Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | | | - Angelo Silverio
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Florent Arregle
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Hélène Martel
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Seyhan Denev
- Department of Cardiology Amiens University Hospital Amiens, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens, Amiens, France
| | - Sandrine Hubert
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Sébastien Renard
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Laurence Camoin
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | | | - Jean Paul Casalta
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Frédérique Gouriet
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Hubert Lepidi
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Didier Raoult
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Michel Drancourt
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Gennaro Galasso
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Daniel C DeSimone
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; IRCCS Neuromed, Pozzilli, Isernia, Italy.
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France; Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Scheggi V, Bohbot Y, Tribouilloy C, Trojette F, Di Lena C, Philip M, Hubert S, Menale S, Zoppetti N, Del Pace S, Stefàno PL, Habib G, Marchionni N. Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations. Heart 2023:heartjnl-2023-322391. [PMID: 37147131 DOI: 10.1136/heartjnl-2023-322391] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE The best strategy to manage patients with left-sided infective endocarditis (IE) and intermediate-length vegetations (10-15 mm) remains uncertain. We aimed to evaluate the role of surgery in patients with intermediate-length vegetations and no other European Society of Cardiology guidelines-approved surgical indication. METHODS We retrospectively enrolled 638 consecutive patients admitted to three academic centres (Amiens, Marseille and Florence University Hospitals) between 2012 and 2022 for left-sided definite IE (native or prosthetic) with intermediate-length vegetations (10-15 mm). We compared four clinical groups: medically (n=50) or surgically (n=345) treated complicated IE, medically (n=194) or surgically (n=49) treated uncomplicated IE. RESULTS Mean age was 67±14 years. Women were 182 (28.6%). The rate of embolic events on admission was 40% in medically treated and 61% in surgically treated complicated IE, 31% in medically treated and 26% in surgically treated uncomplicated IE. The analysis of all-cause mortality showed the lowest 5-year survival rate for medically treated complicated IE (53.7%). We found a similar 5-year survival rate for surgically treated complicated IE (71.4%) and medically treated uncomplicated IE (68.4%). The highest 5-year survival rate was observed in surgically treated uncomplicated IE group (82.4%, log-rank p<0.001). The analysis of the propensity score-matched cohort estimated an HR of 0.23 for uncomplicated IE treated surgically compared with medical therapy (p=0.005, 95% CI: 0.079 to 0.656). CONCLUSIONS Our results suggest that surgery is associated with lower all-cause mortality than medical therapy in patients with uncomplicated left-sided IE with intermediate-length vegetations even in the absence of other guideline-based indications.
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Affiliation(s)
- Valentina Scheggi
- Cardiovascular Medicine, Careggi University Hospital, Florence, Italy
| | - Yohann Bohbot
- Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Christophe Tribouilloy
- Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | | | | | - Mary Philip
- Cardiology, Marseille University Hospital, Marseille, France
| | | | - Silvia Menale
- Cardiology, Careggi University Hospital, Florence, Italy
| | - Nicola Zoppetti
- Istituto di Fisica Applicata "Nello Carrara", National Research Council, Sesto Fiorentino, Italy
| | | | | | - Gilbert Habib
- Cardiologie, Hospital La Timone, Insuffisance cardiaque et valvulopathie, Marseille, France
| | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence and Careggi Hospital, Florence, Italy
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Meidrops K, Burkhardt FJ, Osipovs JD, Petrosina E, Groma V, Stradins P. Etiology, Risk Factors and Clinical Outcomes in Infective Endocarditis Patients Requiring Cardiac Surgery. J Clin Med 2022; 11:jcm11071957. [PMID: 35407565 PMCID: PMC9000117 DOI: 10.3390/jcm11071957] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Infective endocarditis, which may be caused by various microbial agents, severely affects the innermost layer of the heart and often leads to poor clinical outcomes. The purpose of this study was to investigate the etiology, risk factors and short and long-term outcomes of infective endocarditis caused by various bacterial agents in patients requiring cardiac surgery. Methods: One hundred and forty-four patients aged 18 years or above with indications for cardiac surgery due to S. aureus, Streptococcus spp., E. faecalis or coagulase-negative staphylococci caused infective endocarditis were included in this study. Results: S. aureus, Streptococcus spp., E. faecalis and coagulase-negative staphylococci were the causative agents of infective endocarditis in 44 (30.6%), 35 (24.3%), 33 (22.9%) and 32 (22.2%) patients, respectively. The presence of bicuspid aortic valve was the most common predisposing factor confirmed in 19 (23.5%), whereas intravenous drug usage was the most common in 17 (11.8%) patients. No significant differences in intrahospital mortality due to infective endocarditis caused by various bacterial agents were found, however, the worsening of long-term prognosis of endocarditis caused by S. aureus when compared to E. faecalis was confirmed (p = 0.03). The presence of S. aureus was associated with significantly higher rates of embolic complications (p = 0.003). The presence of coagulase-negative staphylococci was associated with prosthetic valve endocarditis (p = 0.015) and perivalvular complications (p = 0.024). Conclusions: In contrast to E. faecalis, the presence of S. aureus determines the worsening of the long-term mortality from infective endocarditis. Perivalvular complications are associated with the presence of coagulase-negative staphylococci.
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Affiliation(s)
- Kristians Meidrops
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Correspondence: ; Tel.: +371-22318008
| | | | - Janis Davis Osipovs
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
| | - Eva Petrosina
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
| | - Valerija Groma
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
| | - Peteris Stradins
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
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