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Zulet P, Vilacosta I, Pozo E, García-Arribas D, Pérez-García CN, Carnero M, Pérez-Camargo D, Montero L, Saiz-Pardo M, Mahía P, Jerónimo A, Islas F, Gómez D, San Román JA, de Agustín JA, Olmos C. Valvulitis: a new echocardiographic criterion for the diagnosis of bioprosthetic aortic valve infective endocarditis. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00097-5. [PMID: 38521440 DOI: 10.1016/j.rec.2024.03.002] [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] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Diffuse homogeneous hypoechoic leaflet thickening, with a wavy leaflet motion documented by transesophageal echocardiography (TEE), has been described in some cases of prosthetic valve endocarditis (PVE) involving aortic bioprosthesis (AoBio-PVE). This echocardiographic finding has been termed valvulitis. We aimed to estimate the prevalence of valvulitis, precisely describe its echocardiographic characteristics, and determine their clinical significance in patients with AoBio-PVE. METHODS From 2011 to 2022, 388 consecutive patients with infective endocarditis (IE) admitted to a tertiary care hospital were prospectively included in a multipurpose database. For this study, all patients with AoBio-PVE (n=86) were selected, and their TEE images were thoroughly evaluated by 3 independent cardiologists to identify all cases of valvulitis. RESULTS The prevalence of isolated valvulitis was 12.8%, and 20.9% of patients had valvulitis accompanied by other classic echocardiographic findings of IE. A total of 9 out of 11 patients with isolated valvulitis had significant valve stenosis, whereas significant aortic valve regurgitation was documented in only 1 patient. Compared with the other patients with AoBio-PVE, cardiac surgery was less frequently performed in patients with isolated valvulitis (27.3% vs 62.7%, P=.017). In 4 out of 5 patients with valve stenosis who did not undergo surgery but underwent follow-up TEE, valve gradients significantly improved with appropriate antibiotic therapy. CONCLUSIONS Valvulitis can be the only echocardiographic finding in infected AoBio and needs to be identified by imaging specialists for early diagnosis. However, this entity is a diagnostic challenge and additional imaging techniques might be required to confirm the diagnosis. Larger series are needed.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Pozo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Daniel García-Arribas
- Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Manuel Carnero
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Daniel Pérez-Camargo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lourdes Montero
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Melchor Saiz-Pardo
- Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Patricia Mahía
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
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Zulet P, Olmos C, Fernández-Pérez C, Del Prado N, Rosillo N, Bernal JL, Gómez D, Vilacosta I, Elola FJ. Regional differences in infective endocarditis epidemiology and outcomes in Spain. A contemporary population-based study. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00038-0. [PMID: 38311023 DOI: 10.1016/j.rec.2024.01.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION AND OBJECTIVES Our aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]). METHODS We conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed. RESULTS A total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions. CONCLUSIONS We found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. https://twitter.com/@pablozf0
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago, Santiago de Compostela, A Coruña, Spain; Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Zulet P, Islas F, Ferrández-Escarabajal M, Bustos A, Cabeza B, Gil-Abizanda S, Vidal M, Martín-Lores I, Hernández-Mateo P, de Agustín JA, Olmos C. Diabetes mellitus is associated to high-risk late gadolinium enhancement and worse outcomes in patients with nonischemic dilated cardiomyopathy. Cardiovasc Diabetol 2024; 23:35. [PMID: 38245750 PMCID: PMC10800059 DOI: 10.1186/s12933-024-02127-z] [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: 10/10/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with a worse prognosis in patients with heart failure. Our aim was to analyze the clinical and imaging features of patients with DM and their association with outcomes in comparison to nondiabetic patients in a cohort of patients with nonischemic dilated cardiomyopathy (DCM). METHODS This is a prospective cohort study of patients with DCM evaluated in a tertiary care center from 2018 to 2021. Transthoracic echocardiography and cardiac magnetic resonance findings were assessed. A high-risk late gadolinium enhancement (LGE) pattern was defined as epicardial, transmural, or septal plus free-wall. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Multivariable analyses were performed to evaluate the impact of DM on outcomes. RESULTS We studied 192 patients, of which 51 (26.6%) had DM. The median left ventricular ejection fraction was 30%, and 106 (55.2%) had LGE. No significant differences were found in systolic function parameters between patients with and without DM. E/e values were higher (15 vs. 11.9, p = 0.025), and both LGE (68.6% vs. 50.4%; p = 0.025) and a high-risk LGE pattern (31.4% vs. 18.5%; p = 0.047) were more frequently found in patients with DM. The primary outcome occurred more frequently in diabetic patients (41.2% vs. 23.6%, p = 0.017). DM was an independent predictor of outcomes (OR 2.01; p = 0.049) and of LGE presence (OR 2.15; p = 0.048) in the multivariable analysis. Patients with both DM and LGE had the highest risk of events (HR 3.1; p = 0.003). CONCLUSION DM is related to a higher presence of LGE in DCM patients and is an independent predictor of outcomes. Patients with DM and LGE had a threefold risk of events. A multimodality imaging approach allows better risk stratification of these patients and may influence therapeutic options.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Marcos Ferrández-Escarabajal
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Ana Bustos
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | - Beatriz Cabeza
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | - Sandra Gil-Abizanda
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - María Vidal
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | - Irene Martín-Lores
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | | | - J Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain.
- Universidad Europea de Madrid, Madrid, Spain.
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de Agustin JA, Pozo Osinalde E, Olmos C, Mahia Casado P, Marcos-Alberca P, Luaces M, Gomez de Diego JJ, Nombela-Franco L, Jimenez-Quevedo P, Tirado-Conte G, Collado Yurrita L, Fernandez-Ortiz A, Perez-Villacastin J. Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:7748. [PMID: 38137816 PMCID: PMC10743683 DOI: 10.3390/jcm12247748] [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] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and "valve in valve" procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.
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Affiliation(s)
- Jose Alberto de Agustin
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Eduardo Pozo Osinalde
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Carmen Olmos
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Patricia Mahia Casado
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Pedro Marcos-Alberca
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - María Luaces
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Jose Juan Gomez de Diego
- Unidad de Imagen Cardiaca, Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.P.O.); (P.M.C.); (P.M.-A.); (M.L.); (J.J.G.d.D.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | | | - Antonio Fernandez-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
| | - Julian Perez-Villacastin
- Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (G.T.-C.); (A.F.-O.); (J.P.-V.)
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Gutierrez-Ortiz E, Olmos C, Carrión-Sanchez I, Jiménez-Quevedo P, Nombela-Franco L, Párraga R, Gil-Abizanda S, Mahía P, Luaces M, de Agustín JA, Islas F. Redefining cardiac damage staging in aortic stenosis: the value of GLS and RVAc. Eur Heart J Cardiovasc Imaging 2023; 24:1608-1617. [PMID: 37315235 DOI: 10.1093/ehjci/jead140] [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: 03/16/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
AIMS Cardiac damage staging has been postulated as a prognostic tool in patients undergoing transcatheter aortic valve replacement (TAVR). The aims of our study are (i) to validate cardiac damage staging systems previously described to stratify patients with aortic stenosis (AS), (ii) to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR, and (iii) to develop a novel staging model and compare its predictive performance to that of the above mentioned. METHODS AND RESULTS Patients undergoing TAVR from 2017 to 2021 were included in a single-centre prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic and Cox's regression analysis were used to identify predictors of 1-year all-cause mortality. In addition, patients were classified based on previously published cardiac damage staging systems, and the predictive performance of the different scores was measured.Four hundred and ninety-six patients (mean age 82.1 ± 5.9 years, 53% female) were included. Mitral regurgitation (MR), left ventricle global longitudinal strain (LV-GLS) and right ventricular-arterial coupling (RVAc) were independent predictors of all-cause 1-year mortality. A new classification system with four different stages was developed using LV-GLS, MR, and RVAc. The area under the receiver operating characteristic curve was 0.66 (95% confidence interval 0.63-0.76), and its predictive performance was superior compared with the previously published systems (P < 0.001). CONCLUSION Cardiac damage staging might have an important role in patients' selection and better timing for TAVR. A model that includes LV-GLS, MR, and RVAc may help to improve prognostic stratification and contribute to better selection of patients undergoing TAVR.
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Affiliation(s)
- Eva Gutierrez-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Irene Carrión-Sanchez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Rocío Párraga
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Sandra Gil-Abizanda
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Patricia Mahía
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - María Luaces
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - José Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
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Sambola A, Lozano-Torres J, Boersma E, Olmos C, Ternacle J, Calvo F, Tribouilloy C, Reskovic-Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Almaghraby A, Iung B, Lancellotti P, Habib G. Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry. Eur Heart J 2023; 44:4566-4575. [PMID: 37592753 DOI: 10.1093/eurheartj/ehad507] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/30/2022] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND AIMS Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. METHODS The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016-18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. RESULTS There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was >10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13-1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54-2.33, P < .0001), history of heart failure (HR 1.53, 95% CI 1.21-1.93, P = .0004), creatinine >2 mg/dL (HR 1.59, 95% CI 1.25-2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08-1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12-1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08-6.79, P < .0001), alcohol abuse (HR 1.45, 95% CI 1.04-2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29-3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05-1.61, P = .016) (C-statistic = .68). CONCLUSIONS Prognosis after LSIE is determined by multiple factors, including vegetation size.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology and Research Institute, Cardiac Intensive Care Unit, University Hospital Valld'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), P° Vall d'Hebron, 119-129, Barcelona 08035, Spain
| | - Jordi Lozano-Torres
- Department of Cardiology and Research Institute, Cardiac Intensive Care Unit, University Hospital Valld'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), P° Vall d'Hebron, 119-129, Barcelona 08035, Spain
| | - Eric Boersma
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Carmen Olmos
- Instituto cardiovascular, Hospital Clínico San Carlos, Instituto de investigación Sanitaria del Hospital Clínico San Carlos, Prof. Martín Lagos s/n, 28040 Madrid, Spain
| | - Julien Ternacle
- Department of Cardiology, SOS Endocarditis, Henri Mondor University Hospital, Creteil, France
| | - Francisco Calvo
- Department of Cardiology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | | | - Vlatka Reskovic-Luksic
- Department of Cardiovascular Diseases, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Seung-Woo Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sebastiaan Bekkers
- Cardiovascular Research Institute Maastricht (CAARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Kwan-Leung Chan
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Bernard Iung
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
| | - Patrizio Lancellotti
- ANMCO Research Center, Florence, Italy
- Department of Cardiology, Heart valve Clinic, University of Liege Hospital, Liege, Belgium
| | - 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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Ballesteros RV, Polo JCG, Olmos C, Vilacosta I. Kounis and Takotsubo, Two Syndromes Bound by Adrenaline: The "ATAK" Complex. Case Rep Cardiol 2023; 2023:7706104. [PMID: 37744893 PMCID: PMC10513855 DOI: 10.1155/2023/7706104] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background. The term "ATAK" complex has been coined by the association of adrenaline, takotsubo, anaphylaxis and Kounis syndrome. We present an uncommon case of an "ATAK" complex with biphasic onset and a midventricular takotsubo pattern. Case Summary. A 50-year-old male was brought to the emergency department in anaphylactic shock. He had progressive exertional dyspnea and angina for the past 2 days. The intravenous administration of adrenaline for anaphylactic shock resulted in chest pain and concerning ECG repolarization findings. The patient was immediately transferred to the catheterization laboratory. Coronary angiography showed a midventricular ballooning pattern without significant coronary stenosis, with subsequent recovery during hospitalization, suggestive of takotsubo syndrome. The allergy tests remained inconclusive for the trigger. Discussion. Adrenaline-mediated stress is the link between these two entities, in which Kounis syndrome itself or anaphylactic shock treatment (adrenaline) are potential triggers for takotsubo syndrome.
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Affiliation(s)
| | - Juan Carlos Gómez Polo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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8
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Zulet P, Olmos C, López J, Vilacosta I, Sáez C, Cabezón G, Gómez D, Jerónimo A, Pérez-Serrano J, San Román JA. Impact of transfer to reference centres and surgical timing on the prognosis of surgically treated patients with infective endocarditis: a prospective multi-centre cohort study. Clin Microbiol Infect 2023; 29:1197.e1-1197.e7. [PMID: 37302571 DOI: 10.1016/j.cmi.2023.06.003] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare outcomes in patients with infective endocarditis (IE) first treated in secondary hospitals and then transferred to reference centres for surgery with those in patients diagnosed in reference centres, and to evaluate the impact of surgery timing on prognosis. METHODS Analysis of a prospective cohort of patients with active IE admitted to three reference centres between 1996 and 2022 who underwent cardiac surgery in the first month after diagnosis. Multi-variable analysis was performed to evaluate the impact of transfer to reference centres and time to surgery on 30-day mortality. Adjusted ORs with 95% CIs were calculated. RESULTS Amongst 703 patients operated on for IE, 385 (54.8%) were referred cases. All-cause 30-day mortality did not differ significantly between referred patients and those diagnosed at reference centres (102/385 [26.5%] vs. 78/385 [24.5%], respectively; p 0.552). Variables independently associated with 30-day mortality in the whole cohort were diabetes (OR, 1.76 [95% CI, 1.15-2.69]), chronic kidney disease (OR, 1.83 [95% CI, 1.08-3.10]), Staphylococcus aureus (OR, 1.88 [95% CI, 1.18-2.98]), septic shock (OR, 2.76 [95% CI, 1.67-4.57]), heart failure (OR, 1.41 [95% CI, 0.85-2.11]), acute renal failure before surgery (OR, 1.76 [95% CI, 1.15-2.69]), and the interaction between transfer to reference centres and surgery timing (OR, 1.18 [95% CI, 1.03-1.35]). Amidst referred patients, time from diagnosis to surgery longer than a week was independently associated with 30-day mortality (OR, 2.19 [95% CI, 1.30-3.69]; p 0.003). CONCLUSION Among referred patients, surgery performed >7 days after diagnosis was associated with two-fold higher 30-day mortality.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Javier Pérez-Serrano
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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9
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Cabezón G, de Miguel M, López J, Vilacosta I, Pulido P, Olmos C, Jerónimo A, Pérez JB, Lozano A, Gómez I, San Román JA. Contemporary Clinical Profile of Left-Sided Native Valve Infective Endocarditis: Influence of the Causative Microorganism. J Clin Med 2023; 12:5441. [PMID: 37685509 PMCID: PMC10487562 DOI: 10.3390/jcm12175441] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/06/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Studies focused on the clinical profile of native valve endocarditis are scarce and outdated. In addition, none of them analyzed differences depending on the causative microorganism. Our objectives are to describe the clinical profile at admission of patients with left-sided native valve infective endocarditis in a contemporary wide series of patients and to compare them among the most frequent etiologies. To do so, we conducted a prospective, observational cohort study including 569 patients with native left-sided endocarditis enrolled from 2006 to 2019. We describe the modes of presentation and the symptoms and signs at admission of these patients and compare them among the five more frequent microbiological etiologies. Coagulase-negative Staphylococci and Enterococci endocarditis patients were the oldest (71 ± 11 years), and episodes caused by Streptococci viridans were less frequently nosocomial (4%). The neurologic, cutaneous or renal modes of presentation were more typical in Staphylococcus aureus endocarditis (28%, p = 0.002), the wasting syndrome of Streptococcus viridans (49%, p < 0.001), and the cardiac in Coagulase-negative Staphylococci, Enterococci and unidentified microorganism endocarditis (45%, 49% and 56%, p < 0.001). The clinical signs agreed with the mode of presentation. In conclusion, the modes of presentation and the clinical picture at admission were tightly associated with the causative microorganism in patients with left-sided native valve endocarditis.
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Affiliation(s)
- Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - María de Miguel
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Paloma Pulido
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Javier B. Pérez
- Instituto de Investigación Sanitaria del Hospital la Princesa (IIS-IP), Hospital Universitario la Princesa, 28006 Madrid, Spain
| | - Adrián Lozano
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Itzíar Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - J. Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
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10
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Cabezón G, López J, Vilacosta I, Habib G, Miró JM, Olmos C, Sarriá C, Hernandez-Meneses M, González-Juanatey C, González-Juanatey JR, Llopis J, Cuervo G, Sáez C, Gómez I, San Román JA. The three-noes right-sided infective endocarditis: An unrecognized type of right-sided endocarditis. Medicine (Baltimore) 2023; 102:e34322. [PMID: 37478259 PMCID: PMC10662813 DOI: 10.1097/md.0000000000034322] [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: 03/27/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
The "3 noes right-sided infective endocarditis" (3no-RSIE: no left-sided, no drug users, no cardiac devices) was first described more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile. Eight tertiary centers with surgical facilities participated in the study. Patients with right-sided endocarditis without left sided involvement, absence of drug use history and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analyzed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis. the study was comprised of 100 patients (mean age 54.1 ± 20 years, 65% male) with definite 3no-RSIE were included (selected from a total of 598 patients with RSIE of all the series, which entails a 16.7% of 3no-RSIE). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent (32% of the group of patients with previous known predisposing heart disease) and fever was the main manifestation at admission (85%). The microbiological profile was led by Staphylococci spp (52%). Vegetations were detected in 94% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, P < .001). Non-community acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died. the clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery may play an important role in improving outcome.
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Affiliation(s)
| | - Javier López
- Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
| | | | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Marseille France
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - José María Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC. Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Olmos
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | - José Ramón González-Juanatey
- Hospital Clínico Universitario, CIBERCV, Santiago DE Compostela, Spain
- IDIS, Insituto de Investigación Sanitaria de Santiago de Compostela
| | - Jaume Llopis
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | | | - Carmen Sáez
- Hospital Universitario La Princesa, Madrid, Spain
| | - Itziar Gómez
- Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
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11
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Zulet-Fraile P, Pérez-García CN, Islas F, López-Nevado C, Cuesta M, Alarcón-García L, Olmos C. Thinking Outside the Heart: Pheochromocytoma as a Rare Cause of Dilated Cardiomyopathy. Am J Med 2023; 136:e69-e70. [PMID: 36566902 DOI: 10.1016/j.amjmed.2022.12.012] [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] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Pablo Zulet-Fraile
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Celia López-Nevado
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, IdSSC, Madrid, Spain
| | - Martín Cuesta
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, IdSSC, Madrid, Spain
| | | | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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12
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Anguita-Gámez M, Zulet P, Islas F, Higueras J, Olmos C. Cardiac imaging high-risk features of malignant mitral valve prolapse. Cardiol J 2022; 29:1047-1048. [PMID: 36541350 PMCID: PMC9788741 DOI: 10.5603/cj.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022] Open
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13
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Islas F, Gutiérrez E, Cachofeiro V, Martínez-Martínez E, Marín G, Olmos C, Carrión I, Gil S, Mahía P, Cobos MÁ, de Agustín A, Luaces M. Importance of cardiac imaging assessment of epicardial adipose tissue after a first episode of myocardial infarction. Front Cardiovasc Med 2022; 9:995367. [PMID: 36451918 PMCID: PMC9702512 DOI: 10.3389/fcvm.2022.995367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/15/2022] [Accepted: 09/29/2022] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Over the past years, information about the crosstalk between the epicardial adipose tissue (EAT) and the cardiovascular system has emerged. Notably, in the context of acute myocardial infarction (AMI), EAT might have a potential role in the pathophysiology of ventricular structural changes and function, and the clinical evolution of patients. This study aims to assess the impact of EAT on morpho-functional changes in the left ventricle (LV) and the outcome of patients after an AMI. METHODS We studied prospectively admitted patients to our hospital with a first episode of AMI. All patients underwent percutaneous coronary intervention (PCI) during admission. Transthoracic echocardiography (TTE) was performed within 24-48 h after PCI, as well as blood samples to assess levels of galectin-3 (Gal-3). Cardiac magnetic resonance (CMR) was performed 5-7 days after PCI. Clinical follow-up was performed at 1 and 5 years after MI. RESULTS Mean age of our cohort (n = 41) was 57.5 ± 10 years, and 38 (93%) were male. Nine patients had normal BMI, 15 had overweight (BMI 25-30), and 17 were obese (BMI > 30). Twenty three patients (56%) had ≥ 4 mm thickness of EAT measured with echo. In these patients, baseline left ventricular ejection fraction (LVEF) after AMI was significantly lower, as well as global longitudinal strain. EAT thickness ≥ 4 m patients presented larger infarct size, higher extracellular volume, and higher T1 times than patients with EAT < 4 mm. As for Gal-3, the median was 16.5 ng/mL [12.7-25.2]. At five-year follow-up 5 patients had major cardiac events, and all of them had EAT ≥ 4 mm. CONCLUSIONS Patients with EAT >4 mm have worse LVEF and GLS, larger infarct size and longer T1 values after a MI, and higher levels of Gal-3. EAT >4 mm was an independent predictor of MACE at 5-year follow-up. EAT thickness is a feasible, noninvasive, low-cost parameter that might provide important information regarding the chronic inflammatory process in the myocardium after an infarction.
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Affiliation(s)
- Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Eva Gutiérrez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Victoria Cachofeiro
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ernesto Martínez-Martínez
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Gema Marín
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Irene Carrión
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Sandra Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Patricia Mahía
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Miguel Ángel Cobos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - María Luaces
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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14
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Ferrandez M, Zulet P, Islas F, Travieso A, De Agustin JA, Goirigolzarri J, Vilacosta I, Olmos C. Development of a new score to predict left ventricular reverse remodelling in patients with nonischemic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1748] [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 and purpose
Implantable cardioverter-defibrillator is indicated in patients with dilated non-ischemic cardiomyopathy (DCM) and severely depressed left ventricular ejection fraction (LVEF) after a wait-and-see period of 3–9 months under optimised medical therapy. However, in the first 6 months after the disease debut, around 2% of patients might suffer life-threatening arrhythmias.
The appearance of left ventricular reverse remodelling (LVRR) in patients with DCM is associated with a lower incidence of ventricular tachyarrhythmias. Therefore, it is relevant an early identification of the patients who will experience LVRR during the follow-up.
Our aim was to develop a score to predict the appearance of LVRR in patients with DCM.
Methods
From 2014 to 2021, 201 patients with DCM and LVEF ≤45% were prospectively evaluated in our tertiary care hospital. All patients underwent a transthoracic echocardiogram and 1.5 Tesla scanner cardiac magnetic resonance (MR) as part of the diagnostic workup. LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50% associated with a reduction in left ventricular end-diastolic diameter ≥10%.
Results
The median age of our cohort (n=201) was 61.6 (14.7) years, and 68% were male. Most patients (>90%) were treated with beta-blockers or RASS blockers, and 72% with mineralocorticoid receptor antagonists.
During a mean follow-up period of 37.6 (33.9) months 45% of patients had LVRR.
Patients with LVRR had a lower cardiovascular mortality (3.33 vs 9.59%; p=0.153), lower mortality due to heart failure (0% vs 8.22%; p=0.023), and a lower incidence of ventricular tachyarrhythmias (1.67% vs 19.18%; p=0.001).
Table 1 shows the echocardiographic, MR and clinical characteristics of patients who experienced LVRR.
Variables significantly associated with LVRR in the univariable analysis and considered clinically relevant were included in a multivariable logistic regression analysis. The final model included the presence of right ventricular end systolic volume index (RVESVi) >50 ml/m2 (2 points), left bundle brach block (LBBB) echo pattern (1 point), female gender (1 point) and tachycardiomyopathy/idiopathic/alcoholic/chemotherapy induced cardiomyopathy as the potencial cause of DCM (1 point).
The score showed a good discrimination, with an area under the ROC curve of 0.82 (95% CI 0.69 to 0.94), 84% sensitivity and 80% specificity. The presence of 3 or more points was associated with a high probability to had LVRR (0 points: 1%; 1 points: 17%; 2 points: 38%; 3 points: 64%; 4 points: 84%%; 5 points: 94% and 6 points: 98%) (Figure 1).
Conclusion
A new score with four variables (RVESV, LBBB echo pattern, female gender and tachycardiomyopathy/idiopatic/alcoholic/chemotheapy induced cardiomyopathy as potential cause) accurately predicts the probability of LVRR. Considering patients who experience LVRR have less cardiovascular events, this score may be a helpful tool for patients' risk stratification.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ferrandez
- San Carlos Clinical University Hospital , Madrid , Spain
| | - P Zulet
- San Carlos Clinical University Hospital , Madrid , Spain
| | - F Islas
- San Carlos Clinical University Hospital , Madrid , Spain
| | - A Travieso
- San Carlos Clinical University Hospital , Madrid , Spain
| | - J A De Agustin
- San Carlos Clinical University Hospital , Madrid , Spain
| | | | - I Vilacosta
- San Carlos Clinical University Hospital , Madrid , Spain
| | - C Olmos
- San Carlos Clinical University Hospital , Madrid , Spain
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15
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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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16
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Lozano Torres J, Sambola A, Magne J, Olmos C, Ternacle J, Calvo F, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Cam Bekkers S, Chan KL, Iung B, Lancellotti P, Habib G. Risk calculator to predict 30-day mortality in left-sided infective endocarditis. The EURO-ENDO score. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1662] [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
Background/Introduction
Infective endocarditis (IE) is associated with high in-hospital mortality, despite improvements in therapeutic strategies. Nonetheless, there is no prospective risk model to estimate IE mortality.
Purpose
We sought to develop and validate a calculator to predict 30-day mortality risk regarding to perform surgery or medical treatment alone in left-sided IE.
Methods
This is a prospective, multicenter registry that included patients between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Patients with possible or definite left-sided IE were included in the analyses. Clinical, biological, microbiological and imaging data were collected. The primary end point was 30-day mortality in patients with left-sided IE. The risk calculator was based on multivariable Cox regression models. The accuracy of the logistic regression models was assessed by discrimination and calibration using C-statistic and Hosmer-Lemeshow test.
Results
Among 3116 patients included, 2171 patients presented left-sided IE and 257 patients (11.8%) died during the first 30 days of IE diagnosis. After multivariable Logistic regression analysis, eleven variables were associated with 30-days mortality and were included in the calculator: previous cardiac surgery, previous stroke/TIA, creatinine >2 mg/dL, S. aureus infection, embolic events on admission, heart failure or cardiogenic shock, vegetation size >14 mm, presence of abscess, severe regurgitation, double left-sided IE and no left valve surgery. There was an excellent correlation between the predicted 30-days mortality in both models with or without performing left valve surgery (area under the receiver operator curve: 0.798 and 0.758, respectively). Moreover, calibration by Hosmer-Lemeshow were 0.085 and 0.09, respectively).
Conclusion(s)
Our risk score in patients with left-sided IE provides an accurate individualized estimation of 30-day mortality according to perform or not perform left-valve surgery. It allows medical professionals to determine whether submitting patients to surgery or not, and thus improve their prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Sambola
- Hospital Universitari Vall d?Hebron , Barcelona , Spain
| | - J Magne
- Dupuytren University Hospital Centre Limoges, Cardiologie , Limoges , France
| | - C Olmos
- Hospital Clinico San Carlos , Madrid , Spain
| | - J Ternacle
- University Hospital Henri Mondor , Creteil , France
| | - F Calvo
- Hospital do Meixoeiro, Cardiología , Vigo , Spain
| | | | | | | | - S W Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S Cam Bekkers
- Maastricht University Medical Centre (MUMC) , Maastricht , The Netherlands
| | - K L Chan
- University of Ottawa, Heart Institute , Ontario , Canada
| | - B Iung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - P Lancellotti
- University Hospital of Liege (CHU), GIGA Cardiovascular Sciences , Liege , Belgium
| | - G Habib
- Hospital La Timone of Marseille , Marseille , France
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17
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Gutierrez E, Carrion I, Olmos C, Jimenez P, Nombela L, Pozo E, Mahia P, Gil S, De Agustin A, Islas F. Cardiac damage staging in patients undergoing TAVR. Incremental value of global longitudinal strain and right ventricular-arterial coupling. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.180] [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
Transcatheter aortic valve replacement (TAVR) is nowadays a safe and increasingly frequent option to treat severe aortic stenosis (AS). Cardiac damage staging has been proposed and validated in some studies as a prognostic tool; however, many patients continue to undergo aortic valve replacement only after there is evidence of cardiac damage. The aim of this study is to assess the potential incremental value of global longitudinal strain (GLS) and right ventricular-arterial coupling (RV-VAc) in the prognostic performance of the cardiac damage staging.
Methods
Consecutive patients with AS and undergoing TAVR were included in our hospital registry. Baseline echocardiography was performed before TAVR according to current guidelines. For this study, patients were classified based on the following stage of cardiac damage: Stage 0: no cardiac damage; Stage 1: left ventricular (LV) damage (LV ejection fraction (LVEF) <50%, LV mass index >95 g/m2 for women, >115 g/m2 for men); Stage 2: left atrial (LA) or mitral valve damage (LA volume index >34 ml/m2, mitral regurgitation moderate-severe, or presence of atrial fibrillation); Stage 3: pulmonary vasculature or tricuspid valve damage (systolic pulmonary artery pressure 60 mmHg, or tricuspid regurgitation moderate-severe); Stage 4: RV damage (TAPSE <1.7 cm, S' <9.5 cm/s).
Results
496 patients were studied. Mean age of the cohort was 81.9±6.2 years, mean aortic valve area was 0.86±0.6 cm2, mean LVEF was 57.9±12.3%, mean LV-GLS was −15.6±3.5% and RV-Vac was 0.61±0.34. Table 1 shows clinical and echo characteristics of patients. Only one patient (0.2%) met criteria for stage 0; 38 (7.7%) patients were in stage 1; 159 (32.1%) patients in stage 2, 157 (31.7%) patients in stage 3 and 141 (28.4%) patients in stage 4. 1-year mortality for stage 1 was (10.5%), for stage 2 (13.7%), for stage 3 (32.2%) and for stage 4 (19.5%). The area under the ROC curve (AUC) for 1-year mortality for the cardiac damage staging system was 0.622, CI (0.539–0.705); the best cut-off value for LV-GLS to predict 1-year mortality was −14% with an AUC of 0.634 CI (0.487–0.781) and RV-VAc had an AUC of 0.748 CI (0.638–858). Finally, the model that included the staging system, LV-GLS and RV-VAc had an AUC ROC of 0.875, CI (0.780–0.971) (Figure 1).
Conclusions
Cardiac damage staging is a good prognostic tool and it has been validated in several studies, however, the addition of feasible and widely available echo parameters such as LV-GLS and RV-VAc can significantly increase its prognostic yield.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Gutierrez
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - I Carrion
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - E Pozo
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - P Mahia
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - S Gil
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
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18
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Ferrández-Escarabajal M, Islas F, Zulet Fraile P, Travieso A, Olmos C. External validation of an algorithm for risk stratification of ventricular arrhythmia in nonischemic dilated cardiomyopathy. Rev Esp Cardiol (Engl Ed) 2022; 75:684-685. [PMID: 35190288 DOI: 10.1016/j.rec.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Marcos Ferrández-Escarabajal
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Pablo Zulet Fraile
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Alejandro Travieso
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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19
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Jerónimo A, Olmos C, Vilacosta I, Sáez C, López J, Sanz M, Cabezón G, Pérez-Serrano JB, Zulet P, San Román JA. Contemporary comparison of infective endocarditis caused by Candida albicans and Candida parapsilosis: a cohort study. Eur J Clin Microbiol Infect Dis 2022; 41:981-987. [PMID: 35568743 DOI: 10.1007/s10096-022-04456-x] [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: 08/18/2021] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
Among 1655 consecutive patients with infective endocarditis treated from 1998 to 2020 in three tertiary care centres, 16 were caused by Candida albicans (CAIE, n = 8) and Candida parapsilosis (CPIE, n = 8). Compared to CAIE, CPIE were more frequently community-acquired. Prosthetic valve involvement was remarkably more common among patients with CPIE. CPIE cases presented a higher rate of positive blood cultures at admission, persistently positive blood cultures after antifungals initiation and positive valve cultures. All patients but four underwent cardiac surgery. Urgent surgery was more frequently performed in CPIE. No differences regarding in-hospital mortality were documented, even after adjusting for therapeutic management.
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Affiliation(s)
- Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Sanz
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Gonzalo Cabezón
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Javier B Pérez-Serrano
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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20
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Citro R, Chan KL, Miglioranza MH, Laroche C, Benvenga RM, Furnaz S, Magne J, Olmos C, Paelinck BP, Pasquet A, Piper C, Salsano A, Savouré A, Park SW, Szymański P, Tattevin P, Vallejo Camazon N, Lancellotti P, Habib G. Clinical profile and outcome of recurrent infective endocarditis. Heart 2022; 108:1729-1736. [PMID: 35641178 DOI: 10.1136/heartjnl-2021-320652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/24/2021] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
AIMS Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE). METHODS Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode. RESULTS 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE. CONCLUSIONS In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Campania, Italy .,IRCCS Neurological Institute of Southern Italy Neuromed, Pozzilli, Molise, Italy
| | - Kwan-Leung Chan
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marcelo Haertel Miglioranza
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil.,Mae de Deus Hospital, Porto Alegre, Brazil.,Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Cécile Laroche
- EurObservational Research Progamme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Rossella Maria Benvenga
- Cardiothoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Campania, Italy
| | - Shumaila Furnaz
- Department of Research, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Julien Magne
- Department of Cardiology, University Hospital Centre of Limoges, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Bernard P Paelinck
- Cardiac Surgery Department, Antwerp University Hospital, Edegem, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Pôle de Recherche Cardiovasculaire (CARD) Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain, Brussels, Belgium
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, DISC Department, Genoa, Italy
| | - Arnaud Savouré
- Cardiology Department, University Hospital of Rouen, Rouen, France
| | - Seung Woo Park
- Heart Stroke Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Gangnam-Gu, Seoul, The Republic of Korea
| | - Piotr Szymański
- Noninvasive Cardiovascular Diagnostic Department, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Poland and Center for Postgraduate Medical Education, Warsaw, Poland
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nuria Vallejo Camazon
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Patrizio Lancellotti
- Department of Cardiology and Cardiovascular Surgery, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.,Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- Service de Cardiologie, Insuffisance Cardiaque et Valvulopathie, Hôpital de la Timone, Marseille, France
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21
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Jerónimo A, Olmos C, Vilacosta I, Ortega-Candil A, Rodríguez-Rey C, Pérez-Castejón MJ, Fernández-Pérez C, Pérez-García CN, García-Arribas D, Ferrera C, Carreras JL. Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections. J Nucl Cardiol 2022; 29:594-608. [PMID: 32748277 DOI: 10.1007/s12350-020-02285-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 04/25/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Utility of 18F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluating the diagnostic performance of FDG-PET imaging in these patients remain limited. Our objective was to assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, differentiating between pocket infection (PI) and lead infection (CIED-IE). METHODS AND RESULTS From 2013 to 2018, all patients (n = 63) admitted to a hospital with suspected CIED infection were prospectively recruited, undergoing a diagnostic work-up including a PET/CT. Explanted devices and material from the pocket were cultured. 14 cases corresponded to isolated PI and 13 were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, sensitivity and specificity of PET/CT for CIED-IE were 38.5% and 98.0%, respectively. Positive (19.2) and negative (0.6) likelihood ratio values, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis when negative. For PI, sensitivity and specificity were 72.2% and 95.6%, respectively. CONCLUSIONS The yield of 18F-FDG PET/CT for suspected CIED infections differs depending on the site of infection. Due to very high specificity but poor sensitivity, negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
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Affiliation(s)
- Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Aida Ortega-Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Rodríguez-Rey
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - María Jesús Pérez-Castejón
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Fernández-Pérez
- Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - José Luis Carreras
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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22
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Agustí C, Cunillera O, Almeda J, Mascort J, Carrillo R, Olmos C, Montoliu A, Alberny M, Molina I, Cayuelas L, Casabona J. Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain). HIV Med 2022; 23:868-879. [DOI: 10.1111/hiv.13270] [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: 11/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cristina Agustí
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
| | - Oriol Cunillera
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
| | - Jesús Almeda
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
- Research Support Unit Primary Health General Directorate of Costa de Ponent Catalan Institute of Health (ICS) Cornellà de Llobregat Spain
| | - Juanjo Mascort
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
- Department of Clinical Sciences Faculty of Medicine University of Barcelona (UB) Barcelona Spain
| | - Ricard Carrillo
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
| | - Carmen Olmos
- Health Department Catalan Government Barcelona Spain
| | - Alexandra Montoliu
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Unit of Infections and Cancer ‐ Information and Interventions (UNIC ‐ I&I) Cancer Epidemiology Research Program (CERP) Hospitalet de Llobregat Barcelona Spain
| | - Mireia Alberny
- Medical Management of Primary Care Servicies STI/HIV Area Catalan Institute of Health (ICS) Barcelona Spain
| | - Izarbe Molina
- Association of Family and Community Nursing of Catalonia (AIFiCC) Barcelona Spain
| | - Laia Cayuelas
- Centro de Atención Primaria Casanova Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Barcelona Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine Universitat Autónoma de Barcelona Badalona Spain
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23
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Cabezón G, López J, Vilacosta I, Sáez C, García-Granja PE, Olmos C, Jerónimo A, Gutiérrez Á, Pulido P, de Miguel M, Gómez I, San Román JA. Reassessment of vegetation size as a sole indication for surgery in left-sided infective endocarditis. J Am Soc Echocardiogr 2021; 35:570-575. [PMID: 34971762 DOI: 10.1016/j.echo.2021.12.013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guidelines recommend surgery in left-sided infective endocarditis (LSIE) associated with large vegetations. Given that most patients who undergo surgery also have other indications (heart failure and/or uncontrolled infection), it is not settled whether surgery should be routinely recommended in patients with large vegetations but no other predictors of poor outcome. METHODS A total of 726 patients with definitive LSIE were included in our analysis. Mean age was 64.9 years, 61% were male. Multivariate analysis of all patients was performed to determine if vegetation size is related to death in LSIE. Then, patients were divided in two groups according to vegetation size: Group A (>10 mm, n=420) and group B (≤10 mm, n=306). Univariate and multivariate analyses of group A patients were carried out to identify the variables related to death in this group. Impact of surgery on mortality of group A patients without heart failure or uncontrolled local infection (n=139) was assessed. RESULTS Age, Staphylococcus aureus, perivalvular complications, heart failure, kidney failure and septic shock, but not vegetation size, were associated with death. Patients with large vegetations showed increased mortality (31.7% in group A vs 24.8% in group B, p=0.045). Group A had more valve rupture and valve regurgitation than group B, but heart failure (55% vs 53%, p=0.678), stroke (22% vs 17.0%, p=0.091), systemic embolism (39% vs 32%, p=0.074), perivalvular complication (28% vs 28%, p=0.865) or septic shock (15% vs 13%, p=0.288) were similar in both groups. In patients from group A without heart failure or uncontrolled infection mortality was similar with and without surgery (n=139; n=70 with surgery, n=69 without surgery; mortality 18.6% vs 11.6% respectively, p=0.251). CONCLUSIONS large vegetations identify patients with poor outcome in LSIE. However, surgery is not associated with a better prognosis in patients with large vegetations if they do not present with another predictor of poor outcome such as heart failure or uncontrolled infection. These findings challenge whether vegetation size alone should be an indication for surgery in LSIE.
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Affiliation(s)
- Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV).
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Hospital Universitario la Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP) Madrid, Spain
| | - Pablo Elpidio García-Granja
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Ángela Gutiérrez
- Hospital Universitario la Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP) Madrid, Spain
| | - Paloma Pulido
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - María de Miguel
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Itzíar Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
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24
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Espejo C, Mejia-Renteria H, Travieso A, Gonzalo N, Fernandez S, Capote ML, Vedia O, Wang L, Nunez-Gil I, Grande Ingelmo JM, Fernandez Rozas I, Olmos C, Vivas D, Escaned J. Myocardial ischaemia of non-obstructive origin as a cause of new onset anginal chest pain in the long COVID syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1078] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
New-onset chest pain occurs in around 20% of patients with long COVID syndrome (LCS). Being the vascular endothelium one of the targets of the SARS-CoV-2 virus, we hypothesized that new onset anginal symptoms in LCS could be due to endothelium dysfunction and other non-obstructive causes of myocardial ischaemia.
Methods
We investigated 11 consecutive patients who developed new onset anginal chest pain, suggestive of myocardial ischaemia, after documented SARS-CoV-2 infection. Intracoronary assessment included endothelium-dependent evaluation with acetylcholine testing (Ach), and endothelium-independent assessment with coronary flow reserve (CFR) and microcirculatory resistance (MR). Criteria for positiveness of these tests and medical treatment recommendation were obtained from 2019 ESC guidelines and 2020 EAPCI consensus document on ischaemia with non-obstructive coronary arteries (INOCA).
Results
Mean patient age was 56 years (SD ± 15); 10 (91%) were female. In the acute COVID-19 phase, 4 patients (36%) had had pulmonary infiltrates and 2 (18%) required hospitalization. Conclusive non-invasive tests were obtained in 7 (64%), showing exercise-related myocardial ischaemia in 6 (86%). Coronary angiography ruled out obstructive epicardial stenoses in all the patients. Ach testing revealed abnormal endothelium-dependent responses in 9 (82%) patients: 5 (56%) had epicardial vessel and 4 (44%) microvascular spasm. Endothelium-independent assessment was abnormal in 6 (54%) cases, with abnormal CFR in 2 (33%), abnormal MR in 2 (33) and both abnormal CFR and MR in 2 (33%) patients. The most frequent endotype was combined endothelium dependent- and independent abnormalities (6/9, 67%). Stratified medical treatment according to endotype led to significant improvement in Seattle Angina Scores for angina frequency (+22 points, p=0.013) and a notable trend towards angina stability (+25 points, p=0.093) at a mean follow-up time of 222 days.
Conclusions
Myocardial ischaemia of non-obstructive origin is common in patients with chest pain and LCS. Vasomotor abnormalities related to endothelial dysfunction occurred in 82% of patients, frequently associated to impaired microvascular vasodilation or high microvascular resistance. Stratified medical treatment led to significant improvement in angina stability and frequency.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Espejo
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - A Travieso
- Hospital Clinico San Carlos, Madrid, Spain
| | - N Gonzalo
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - M L Capote
- Hospital Clinico San Carlos, Madrid, Spain
| | - O Vedia
- Hospital Clinico San Carlos, Madrid, Spain
| | - L Wang
- Hospital Clinico San Carlos, Madrid, Spain
| | | | | | | | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - D Vivas
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Escaned
- Hospital Clinico San Carlos, Madrid, Spain
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25
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Islas F, De Agustin A, Jimenez P, Nombela L, Marcos Alberca P, Seabra D, Olmos C, Lepori A, Mahia P, Perez De Isla L. The discongruence index, a simple predictor of cardiac remodeling after transcatheter aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.086] [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
Aortic stenosis causes several changes in left ventricular (LV) geometry and function; cardiac remodeling after transcatheter aortic valve replacement (TAVR) is variable among patients and it is not clearly defined. The aim of this study is to identify factors associated with LV functional and structural recovery.
Methods
428 patients were retrospectively studied; all patients underwent transthoracic echocardiography prior to TAVR; specific measurements such as maximum internal diameter of the prosthetic valve, nominal loss and percentage of nominal loss regarding to valve size, as well as the discongruence index (Prosthesis size/BSA) were evaluated at discharge and 1-year follow up. Positive cardiac remodeling (PCR) was considered if patients had a reduction of ≥20% of left ventricle mass index (LVMi) and ≥10% of end-diastolic volume index (LVEDVi).
Results
Mean age of the cohort was 83±5.6 years, 55% were female (n=236), mean aortic valve area was 0.7±0.2cm2; mean LVMi and LVEDVi were 129.4±35.4gr/m2 and 54.5±22ml/m2 respectively. LVMi reduction ≥20% was observed in 30% (n=128) of patients; LVEDVi reduction ≥10% was observed in 44% (n=188) of patients. A total of 107 patients (25%) showed PCR. Female patients showed more PCR (p=0.04). Discongruence index was significantly higher in patients with PCR (15.5±1.9 vs 14.5±1.8, p=0.01) and was significantly associated to LVMi (121.5±28.9 vs 150.8±41.1g/m2) and LVEDVi individually (55.1±17.2 vs 42.7±16.7ml/m2; p<0.01). Left ventricular ejection fraction (LVEF) had a statistically significant increase among patients with PCR (53.2±14.9 vs 56.7±11.5, p=0.04) global longitudinal strain showed improvement at 1-year follow-up as well, although not statistically significant (−17.3±3.7 vs −18.3±3.4 p=0.53).
Conclusions
The discongruence index is a simple and feasible parameter that can predict positive cardiac remodeling after TAVR which can have a significant impact in clinical outcome of patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Marcos Alberca
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - D Seabra
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Lepori
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Mahia
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Perez De Isla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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26
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Islas F, Bottino R, Jimenez P, Nombela L, Marcos Alberca P, D'Amato M, Lepori A, Olmos C, Perez De Isla L, De Agustin A. Ventricular-arterial coupling in hypertensive patients after TAVR. It is not all about the valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0125] [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
In severe aortic stenosis, the left ventricle faces the challenge of the valvular load and the arterial load caused by abnormalities in systemic arterial compliance and systemic vascular resistance. The aim of this study is to assess the effect of hypertension control on left ventricular performance in patients that underwent TAVR.
Methods
68 consecutive patients who underwent TAVR were analyzed; all patients were evaluated to confirm severe aortic stenosis with transthoracic echo (TTE). Conventional echo parameters were assessed as well as left ventricular mechanics parameters and vascular parameters such as arterial elastance (Ea), ventricular elastance (Ees) and V/Ac; besides all patients underwent TTE prior to TAVR, at discharge and 90 days follow-up visit.
Results
Mean age was 82±5; mean aortic valve area was 0.69±0.19, mean left ventricular ejection fraction was 58.3±12.1 and mean ventricular-arterial coupling was 1.6±0.9. At 90 days follow up we observed a significant worsening in V/Ac in those patients with poor control of blood pressure (>140/90mmHg), (1.8±0.5 vs 2.1±0.3, p=0.03). Aortic impedance was significantly higher (4.4±1.4 vs 3.5±1.2, p=0.05); Ea and Ees were also significantly higher in hypertensive patients (2.3±0.8 vs 1.7±0.6, p=0.05) and (1.4±0.7 vs 0.9±0.6, p=0.01) respectively. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed a slightly reduction in hypertensive patients, although not statistically significant.
Conclusions
Control of blood pressure seems to be an important factor that contributes to a better or rather worse LV performance and could have a potential role in systolic function and clinical outcome of patients after TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - R Bottino
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Marcos Alberca
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - M D'Amato
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Lepori
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Perez De Isla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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27
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Jeronimo A, Olmos C, Perez-Garcia CN, Ferrera Duran C, Garcia-Granja PE, Lopez Diaz J, Saez Bejar C, Sarria Cepeda C, Alcazar MC, San Roman A, Vilacosta I. Contemporary comparison of infective endocarditis caused by Candida albicans and Candida parapsilosis: a cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1714] [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
Although Candida albicans is the most frequent microorganism causing fungal endocarditis, its incidence has decreased during the last two decades, and that of non-albicans Candida species has risen. Among the last, Candida parapsilosis is of particular interest, representing the second most frequent Candida species causing IE1, 2.
Purpose
To compare the clinical course, imaging findings and outcomes among patients with IE caused by C. albicans (CAIE) and C. parapsilosis (CPIE) in order to identify organism-specific peculiarities.
Methods
From January 1998 to June 2020, all consecutive cases of CAIE and CPIE (n=16), admitted to a hospital network composed of 3 tertiary hospitals and prospectively recruited on a multipurpose database, were retrospectively analysed. All cases were evaluated by the Endocarditis Team (ET) and underwent a thorough diagnostic work-up, including blood cultures at admission, transoesophageal echocardiography (TEE) and culture of the valves extracted at surgery. Other imaging tests, such as PET/CT, were performed at the ET's discretion. Diagnosis of IE was made according to the modified Duke criteria until 20153, and the European Society of Cardiology (ESC) 2015 modified diagnostic criteria thereafter4.
Results
Eight patients were diagnosed with CAIE and 8 with CPIE. Regarding predisposing conditions, a higher prevalence of prosthetic valves was found among CPIE. Other population's baseline information is shown in Table 1. Compared to CAIE, CPIE presented a longer time from the beginning of symptoms to hospital admission (40 vs 7 days; p=0.062), but no differences regarding signs and symptoms were observed. Aortic location was the most frequent infection side in both groups, but prosthetic valve involvement was remarkably more frequent among patients with CPIE (75% vs 37.5%; p=0.315. Figure 1). CPIE also presented a higher rate of positive blood cultures at admission (100% vs 62.5%; p=0.200), persistently blood cultures 48–72 hours after antifungals initiation (100% vs 0%; p=0.021) and positive valve cultures (83.3% vs 57.1%; p=0.569). No differences regarding TEE and other imaging tests findings were observed. All patients but 4 underwent valve replacement surgery. No differences in in-hospital complications or in mortality were observed between CAIE and CPIE, even after adjusting for therapeutic management.
Conclusions
Compared to CAIE, CPIE presented a more frequent involvement of prosthetic valves, a longer course of symptoms before admission and a bigger proportion of persistently positive blood cultures. In-hospital complications and mortality were similar between the two groups.
Funding Acknowledgement
Type of funding sources: None. Table 1. Population characteristicsFigure 1. Valve involvement distribution
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Affiliation(s)
- A Jeronimo
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Olmos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C N Perez-Garcia
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Ferrera Duran
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | | | - J Lopez Diaz
- University Hospital Clinic of Valladolid, Valladolid, Spain
| | - C Saez Bejar
- Hospital Universitario La Princesa, Madrid, Spain
| | | | - M C Alcazar
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A San Roman
- University Hospital Clinic of Valladolid, Valladolid, Spain
| | - I Vilacosta
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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28
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Perez Garcia CN, Olmos C, Garcia Arribas D, Lopez J, Ladron R, San Roman JA, Jeronimo A, Islas F, Ferrera C, Saenz-Bejar C, Vilacosta I. Impact of frailty on elderly patients with infective endocarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2830] [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
Introduction
Frailty studies focused on patients with infective endocarditis (IE) are scarce and its potential impact on patient outcomes is not well known.
The aim of this study is to describe the clinical profile and prognosis of elderly patients with IE, comparing patients who met the frailty criteria versus those who did not.
Methods
A total of 121 cases of confirmed IE were consecutively collected in three tertiary hospitals between 2017 and 2019. The patients were classified into two groups: Group I (n=49), patients with IE who met the Frail criteria for frailty, and Group II (n=72), those patients without frailty by this scale.
Results
The median age of our cohort was 77 years (69–82), and 62.8% were men. Frail patients were older than those in Group II, as shown in Table 1.
Regarding comorbidity, chronic anemia (40.8% vs 25%; p<0.060) was more common in Group I, as well as rheumatic manifestations at admission (12.2% vs 1.4%; p=0.014).
The most frequently isolated microorganisms were S. aureus (n=25), coagulase negative staphylococci (n=25), viridans group streptococci (n=14), and enterococci (n=14). Enterococci (16.3% vs 8.3%, p=0.177) and non-viridans streptococci (10.2% vs 2.8%); p=0.086) were more frequent in frail patients.
Vegetation (79.6% vs 80.6%; p=0.896) and periannular complications (24.5% vs 29.2%; p=0.571) were similar in both groups. No significant differences were found regarding the location of the infection.
The incidence of in-hospital complications was similar between both groups. Frail patients underwent surgery less frequently than those in Group II, and had higher predicted mortality on surgical risk scale scores. However, the percentage of patients who met the surgical criteria and were considered inoperable was similar (33.3% vs 26.2%; p=0.415). In-hospital mortality was similar in both groups. When analyzing in-hospital mortality according to the therapeutic strategy in Group I, a mortality of 34.5% was observed in frail patients with conservative medical treatment, compared to 47.1% in those patients who underwent surgery in the same group.
One third of our patients received outpatient antibiotic treatment, being significantly more frequent in Group I (39.6% vs 29.0%; p=0.232).
Conclusions
The elderly patients with IE and frailty criteria were older and more frequently had rheumatic symptoms at admission. Enterococci and non-viridans streptococci were isolated more frequently than in non-frailty patients. Surgery was less performed among frail patients, who had a higher predicted surgical risk. Although complications and in-hospital mortality were similar between both groups, in the group of frail patients, those with conservative management showed lower mortality compared to surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C N Perez Garcia
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Olmos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - D Garcia Arribas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Lopez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - R Ladron
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - J A San Roman
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - A Jeronimo
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - F Islas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Ferrera
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | | | - I Vilacosta
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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29
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Sambola A, Lozano Torres J, Olmos C, Ternacle J, Calvo-Iglesias FE, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Arregle F, Lung B, Lancellotti P, Habib G. Predictors of mortality in patients with left-side infective endocarditis, the ESC-EORP EURO-ENDO registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1716] [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/Introduction
Infective endocarditis (IE) is associated with high in-hospital mortality, ranging from 16% to 25%, despite improvement in diagnostic and therapeutic strategies, mainly due to complications and heterogeneity of the disease. Baseline risk stratification is essential, in order to focus an aggressive management toward high-risk patients.
Purpose
We sought to assess the association between surgery and 30-day mortality rate as related to vegetation size.
Methods
The ESC-EORP EURO-ENDO registry is a prospective multicentre observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Multivariable logistic regression analysis was performed to assess variables associated with 30-day mortality. Besides, univariable analysis was performed to assess best vegetation size cut-off related to 30-day mortality.
Results
Among 2171 patients with left-side IE, 257 patients (11.8%) died during the first 30 days of IE diagnosis. Patient characteristics and univariable analysis are summarized in TABLE 1. Cut-off value for best vegetation size related to 30-day mortality was vegetation length >14mm, with a HR =2.00 (95% CI 1.59–2.51, p<0.0001) and a Harrell's Concordance of 0.58. After multivariable logistic regression analysis, factors associated with 30-day mortality risk were: vegetation size >14mm (OR =2.68, 95% CI [1.96–3.67], p<0.0001), previous stroke or transient ischemic attack (TIA) (OR =1.60, 95% CI [1.07–2.40], p=0.0235), creatinine >2mg/dL (OR =2.45, 95% CI [1.73–3.47], p<0.0001), presence of embolic events (OR =2.64, 95% CI [1.86–3.74], p<0.0001), hemorrhagic stroke (OR=3.71, 95% CI [1.80–7.64], p=0.0004), presence of heart failure or cardiogenic shock (OR =3.50, 95% CI [2.57–4.77], p<0.0001) and no cardiac surgery during the event (OR =4.07, 95% CI [2.93–5.67], p<0.0001). The C-statistic of the logistic model to predict 30-day mortality was 0.795.
Conclusion
Left-side infective endocarditis had a high 30-day mortality rate (11.8%). Presence of a large vegetation size (>14mm), embolic events, hemorrhagic stroke, renal failure, presence of heart failure or cardiogenic shock were associated with an increase in 30-day mortality. Performing cardiac surgery had a protective effect.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC-EORP EURO-ENDO project from the ESC society
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Affiliation(s)
- A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Lozano Torres
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Ternacle
- Henri Mondor University Hospital Chenevier APHP, Creteil, France
| | | | | | | | | | - S W Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K L Chan
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - F Arregle
- APHM La Timone Hospital, Marseille, France
| | - B Lung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
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30
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Ferrandez M, Islas F, Travieso A, Diz-Diaz J, Restrepo A, Goirigolzarri J, Luaces M, De Agustin JA, Bustos A, Olmos C. Cardiac mechanics as predictors of left ventricular reverse remodelling in patients with dilated non-ischemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0281] [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
Background and purpose
The appearance of left ventricular reverse remodelling (LVRR) is associated with a better prognosis in patients with dilated non-ischemic cardiomyopathy (DCM).
Our aim was to identify cardiac imaging parameters, including speckle tracking by transthoracic echocardiography (TTE) and feature tracking by CMR, associated with LVRR in a prospective cohort of patients with DCM.
Methods
From 2014 to 2021, 182 patients with DCM and left ventricle ejection fraction (LVEF) <40% were prospectively evaluated in our hospital.
LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50%, associated with a reduction in left ventricular end- diastolic diameter ≥10%.
Patients underwent multimodality imaging evaluation including CMR with a 1.5 Tesla scanner, and TTE. Cardiac mechanics, including global longitudinal strain (GLS), strain rate (SR) and mechanical dispersion (MD) were measured.
Results
Median age of our cohort was 62.3 (14.4) years, and 67.7% were male.
Most patients (>90%) were treated with beta-blockers or RASS blockers, and 67% with mineralocorticoid receptor antagonists. 30% had cardiac resynchronization therapy (CRT) and 37% had ICD as primary prevention. Mean LVEF was 31.3%. During a mean follow-up period of 35.9 (35.4) months, 38.3% of patients had LVRR.
Age and gender distribution were similar in both groups. Regarding cardiovascular risk factors and pharmacological treatment, no differences were found between patients with and without LVRR. Baseline CRT therapy was not associated with LVRR (22.6% vs 34.7%; p=0.249). However, there was a trend towards higher LVRR in those who received CRT during follow-up 18.8% vs 0%; p=0.069).
Patients who experienced LVRR had lower basal LVEF (23.4% vs 29%; p<0.008), as well as poorer RV function, including lower RVEF (40.5% vs 51%; p=0.006) and lower TAPSE (16 mm vs 19 mm; p=0.021). Regarding cardiac mechanics, those patients with lower GLS (−9% vs −12%; p=0.001), and higher MD (73 mm vs 55 mm; p=0,050) had LVRR more frequently during follow-up. The presence of a left bundle branch block (LBBB) contraction pattern by strain was associated with higher rate of LVRR (83.3% vs 30.4%; p=0.011). The burden of fibrosis measured by LGE with CMR was not associated with LVRR (14% vs 12%; p=NS).
Patients with LVRR had a lower cardiovascular mortality (3.3 vs 14.3%; p=0.117), lower mortality due to heart failure (0% vs 12.2%; p=0.046), less heart failure hospitalizations (20% vs 46.9%; p=0.016), and a lower incidence of ventricular tachyarrhythmias (3.3% vs 18.4%; p=0.051).
Conclusions
LVRR in patients with DCM receiving optimized medical therapy is associated with a better prognosis. Imaging parameters, including a lower basal LVEF, RVEF, GLS and higher MD, as well as LBBB echo pattern, were associated with a higher frequency of LVRR, and might help to identify patients who could benefit from CRT/and may be helpful to stratify patients's risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ferrandez
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - F Islas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A Travieso
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Diz-Diaz
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A Restrepo
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Goirigolzarri
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - M Luaces
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J A De Agustin
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A Bustos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Olmos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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Sambola A, Lozano Torres J, Olmos C, Ternacle J, Calvo-Iglesias FE, Tribouilloy C, Reskovic Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Arregle F, Lung B, Lancellotti P, Habib G. Predictors of mortality in patients with right-side and cardiac device-related infective endocarditis, the esc-eorp euro-endo registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1717] [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/Introduction
Mortality in right-sided infective endocarditis (RSIE) and cardiac device-related IE (CDRIE) rates have increased mainly due derived complications and heterogeneity of the disease. A better understanding of associated risk factors to mortality in these entities are required in order to develop an efficient therapy.
Purpose
The aim of this study was to assess 30-day mortality rate and variables associated in RSIE and CDRIE.
Methods
The ESC-EORP EURO-ENDO registry is a prospective multicenter observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Univariable analysis was performed to assess variables associated with 30-day mortality.
Results
Among 269 patients with RSIE, 24 patients (9.8%) died during the first 30-day of IE diagnosis. Cut-off value for best vegetation size related to 30-day mortality was vegetation length >19mm, with a HR = 2.88 (95% CI 1.26–6.58, p=0.01) and a Harrell's Concordance of 0.632. Factors associated with 30-days mortality by univariable analysis were: vegetation size >19mm (OR = 2.99, 95% CI [1.31–6.84], p=0.009), previous stroke or transient ischemic attack (OR = 5.10, 95% CI [1.19–21.88], p=0.029), HIV infection (OR = 3.52, 95% CI [1.03–12.10], p=0.046), chronic renal failure (OR = 2.66, 95% CI [1.06–6.71], p=0.038), congestive heart failure at admission (OR = 2.34, 95% CI [1.00–5.47], p=0.050) and severe regurgitation (OR = 3.77, 95% CI [1.56–9.09], p=0.003).
On the other side, among the 227 patients with CDRIE, 24 patients (8.8%) died during the first 30-day of IE diagnosis. Factors associated with an increase in 30-day mortality by univariate analysis were: age per 10 years (OR = 1.49, 95% CI [1.02–2.18], p=0.039), heart failure history (OR = 3.88, 95% CI [1.39–10.80], p=0.009), congestive heart failure on admission (OR = 5.80, 95% CI [2.31–14.55], p<0.001) and cardiogenic shock on admission (OR = 13.37, 95% CI [3.75–47.64], p<0.001). An increase in left ventricular ejection fraction (LVEF) per 10% was a protective factor (OR = 0.66, 95% CI [0.49–0.90], p=0.008).
Conclusions
Patients with RSIE and CDRIE had a not negligible 30-day mortality rate (9.8% and 8.8%, respectively). Factors associated with RSIE and CDRIE mortality are different; while in the right side location, the mortality was related with vegetation size and comorbidities, in the case of CDRIE, the mortality was mainly associated to the presence of heart failure.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Euro-Endo registry by European Society of Cardiology
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Affiliation(s)
- A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Lozano Torres
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Ternacle
- University Hospital Henri Mondor, Creteil, France
| | | | | | | | | | - S W Park
- Asan Medical Center, Seoul, Korea (Republic of)
| | - S Bekkers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K L Chan
- Asan Medical Center, Seoul, Korea (Republic of)
| | - F Arregle
- APHM La Timone Hospital, Marseille, France
| | - B Lung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
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32
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Garcia Granja PE, Lopez J, Vilacosta I, Saéz C, Cabezón G, Olmos C, Jerónimo A, Pérez JB, De Stefano S, Maroto L, Carnero M, Monguio E, Pulido P, de Miguel M, Gomez Salvador I, Carrasco-Moraleja M, San Román JA. Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile. Heart 2021; 107:1987-1994. [PMID: 34509995 DOI: 10.1136/heartjnl-2021-319661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/10/2021] [Accepted: 08/22/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication. METHODS 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication. RESULTS Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632). CONCLUSIONS Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
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Affiliation(s)
- Pablo Elpidio Garcia Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain .,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Lopez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Saéz
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Adrián Jerónimo
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Javier B Pérez
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Salvatore De Stefano
- Department of Cardiac Surgery. Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Luis Maroto
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Emilio Monguio
- Department of Cardiac Surgery, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain
| | - Paloma Pulido
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - María de Miguel
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Itziar Gomez Salvador
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco-Moraleja
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Pérez-García CN, Enríquez-Vázquez D, Méndez-Bailón M, Olmos C, Gómez-Polo JC, Iguarán R, Ramos-López N, García-Klepzig JL, Ferrández-Escarabajal M, Jerónimo A, Martínez-Gómez E, Font-Urgelles J, Fragiel-Saavedra M, Paz-Arias P, Romero-Delgado T, Gómez-Álvarez Z, Playán-Escribano J, Jaén E, Vargas G, González E, Orviz E, Burruezo I, Calvo A, Nieto Á, Molino Á, Lorenzo-Villalba N, Andrès E, Macaya C, Vilacosta I. The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients. J Clin Med 2021; 10:jcm10040825. [PMID: 33670462 PMCID: PMC7922313 DOI: 10.3390/jcm10040825] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.
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Affiliation(s)
- Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
- Correspondence: ; Tel.: +34-913302712; Fax: +34-913303290
| | - Daniel Enríquez-Vázquez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Manuel Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Juan Carlos Gómez-Polo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Rosario Iguarán
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Noemí Ramos-López
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - José Luis García-Klepzig
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Marcos Ferrández-Escarabajal
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Eduardo Martínez-Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | | | - Marcos Fragiel-Saavedra
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Pilar Paz-Arias
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Teresa Romero-Delgado
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Zaira Gómez-Álvarez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Julia Playán-Escribano
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Esther Jaén
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Gianna Vargas
- Servicio de Neumología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (G.V.); (E.G.)
| | - Elizabeth González
- Servicio de Neumología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (G.V.); (E.G.)
| | - Eva Orviz
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Irene Burruezo
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Alberto Calvo
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Ángel Nieto
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Ángel Molino
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Noël Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Carlos Macaya
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
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García-Arribas D, Olmos C, Vilacosta I, Perez-García CN, Ferrera C, Jerónimo A, Carnero M, Ortega Candil A, Sáez C, García-Granja PE, Sarriá C, López J, San Román JA, Maroto L. Infective endocarditis in patients with aortic grafts. Int J Cardiol 2021; 330:148-157. [PMID: 33592240 DOI: 10.1016/j.ijcard.2021.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/19/2020] [Revised: 01/30/2021] [Accepted: 02/10/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Infective endocarditis (IE) in patients with a valve-tube ascending aortic graft (AAG) is a rare entity with a challenging diagnosis and treatment. This study describes the clinical features, diagnosis and outcome of these patients. METHODS Between 1996 and 2019, 1654 episodes of IE were recruited in 3 centres, of which 37 patients (2.2%) had prosthetic aortic valve and AAG-IE (21 composite valve graft, 16 supracoronary graft) and conformed our study group. RESULTS Patients with aortic grafts were predominantly male (91.9%) and the mean age was 67.7 years. Staphylococci were the most frequently isolated microorganisms (32%). Viridans group streptococci were only isolated in patients with composite valve graft. TEE was positive in 89.2%. PET/CT was positive in all 15 patients in whom it was performed. Surgical treatment was performed in 62.2% of patients. In-hospital mortality was 16.2%. Heart failure and the type of infected graft (supracoronary aortic graft) were associated with mortality. Mortality among operated patients was 21.7%. Interestingly, 14 patients received antibiotic therapy alone, and only one died. Mortality was lower among patients with a composite valve graft compared to those with a supracoronary graft (4.8% vs 31.3%; p = 0.03). CONCLUSIONS In patients with AAG and prosthetic aortic valve IE, mortality is not higher than in other patients with prosthetic IE. Multimodality imaging plays an important role in the diagnosis and management of these patients. Heart failure and the type of surgery were risk factors associated with in-hospital mortality. Although surgical treatment is usually recommended, a conservative management might be a valid alternative treatment in selected patients.
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Affiliation(s)
- Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain.
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Carlos Nicolás Perez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Manuel Carnero
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Aida Ortega Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, C/ Diego de León, 62, Madrid 28006, Spain
| | - Pablo-Elpidio García-Granja
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, Valladolid 47003, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, C/ Diego de León, 62, Madrid 28006, Spain
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, Valladolid 47003, Spain
| | - José Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, Valladolid 47003, Spain
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
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Travieso Gonzalez A, Romero Delgado T, Luque Diaz TS, Islas F, Olmos C, Higueras Nafria J, Vivas D, Mahia Casado P, Vilacosta I. Multivariate analysis of right ventricle echocardiographic function parameters for the prediction of outcomes in significant functional tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.064] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Functional tricuspid regurgitation is a common disease that significantly impairs survival and quality of life. The role of echocardiographic right ventricular (RV) function parameters to detect patients with worse prognosis that may benefit from invasive treatment is still under debate.
Methods
121 consecutive patients with grade III and IV functional tricuspid regurgitation were evaluated. RV function parameters and clinical variables were assessed at baseline, and then patients were prospectively followed-up. The primary endpoint was the combination of death or heart failure (HF) admissions. Comparison of imaging parameters was done using receiver-operating characteristics (ROC) curves. Multivariate logistic regression analysis was preformed to establish independent predictors of outcomes.
Results
Median follow up was 27.3 months. 73.6% of the patients were female, and mean age was 80.4 years. 63.6% were grade IV tricuspid regurgitation.
In the univariate analysis using the area under the ROC curve (AUC), RV-free wall strain (RVS, AUC = 0.633) and pulmonary artery systolic pressure (PASP, AUC = 0.605) were the best predictors of death and HF admissions, showing better diagnostic performance than tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and tricuspid S’ (p < 0.001 for each comparison) (graph 1A).
In the multivariate analysis including either clinical and echocardiographic variables, independent predictors of death and HF admissions were Age (OR 1.07, p = 0.029), RVS>-16 (OR 5.0, p = 0.001), Diabetes mellitus (OR 3.0, p = 0.011), eGFR (ml/min, OR 0.96, p = 0.001) and Hemoglobin (g/dL, OR = 0.74, p = 0.048) (table 1). The model including these variables was superior than RVS and PASP alone (AUC 0.884, p < 0.001) (graph 1B), showing high sensitivity (78.8%) and moderate specificity (67.3%).
Conclusions
In patients with significant functional tricuspid regurgitation, RVS and PASP show the best performance for the detection of death and HF admissions. A multivariate model including age, diabetes, eGFR, hemoglobin and RVS was superior than the individual imaging parameters.
Table 1 Variable OR 95% CI P value Age (years) 1.07 1.01-1.13 0.029 Diabetes Mellitus 3.00 1.29-7.00 0.011 RV free wall strain >-16 5.01 1.87-13.4 0.001 Hemoglobin (d/dL) 0.74 0.55-1.00 0.048 eGFR (ml/min) 0.96 0.94-0.98 0.001 OR odds ratio. CI: confidence interval. eGFR: estimated glomerular filtration rate (CKD-EPI formula). Abstract Figure. Graph 1
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Affiliation(s)
| | | | | | - F Islas
- Hospital Clinico San Carlos, Madrid, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - D Vivas
- Hospital Clinico San Carlos, Madrid, Spain
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Martínez-Gómez E, Higueras J, Olmos C. Constrictive physiology due to epicardial fat. Rev Esp Cardiol (Engl Ed) 2020; 73:1066-1068. [PMID: 32600995 DOI: 10.1016/j.rec.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | - Javier Higueras
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
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Jeronimo Baza A, Olmos C, Vilacosta I, Ortega-Candil A, Rodriguez-Rey C, Perez-Castejon M, Fernandez-Perez C, Perez-Garcia C, Garcia-Arribas D, Ferrera C, Carreras J. Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections: good for pocket, not so good for endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0285] [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
Introduction
The usefulness of 18F-FDG PET/CT in the diagnosis of infective endocarditis (IE) associated with cardiac implantable electronic devices (CIED) is not well established.
Purpose
To assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, placing special emphasis on differentiating between pocket infection (PI) and CIED-IE.
Methods
From 2013 to 2018, all patients (n=63) admitted to a tertiary care hospital with suspected CIED infection were prospectively recruited, undergoing a thorough diagnostic work-up that included blood cultures extraction, transthoracic (TTE) and transoesophageal echocardiography (TEE) and a PET/CT. When device explantation was required, material from the pocket, generator and leads were also cultured. The gold standard for the diagnosis of CIED-IE was a positive lead culture in the absence of PI when percutaneous extraction was performed or a positive culture from a surgically removed lead. In spite of negative lead cultures, the presence of typical TEE images of vegetations in a clinical context of positive blood cultures was also considered as CIED-IE.
Results
After the whole diagnostic process, 14 (22.2%) cases corresponded to isolated PI and 13 (20.6%) were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, values of sensitivity, specificity and global diagnostic accuracy of PET/CT for CIED-IE were 38.5%, 98.0% and 85.7%, respectively. Positive and negative likelihood ratio values, 19.2 and 0.6 respectively, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis in case of a negative result. In the case of PI, fair sensitivity (72.2%) and good specificity values (95.6%) were obtained. Extracardiac lead SUVmax and SUVratio in PI were good, with an area under the ROC curve (AUC) of 0.870 and 0.879, respectively. However, semiquantitative analysis was not useful for the diagnosis of CIED-IE.
Conclusions
In patients with suspected CIED infection, the yield of 18F-FDG PET/CT differs depending on the site of infection, showing a very high specificity but poor sensitivity in CIED-IE; so negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
ROC curves SUVmax and SUV ratio for PI
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | - C Ferrera
- Hospital Clinico San Carlos, Madrid, Spain
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Lopez Diaz J, Garcia Granja P, Sevilla M, Revilla A, Vilacosta I, Olmos C, Ladron R, Gomez I, Cabezon G, San Roman J. Inter and intraobserver variability in the echocardiographic measurement of vegetations in infective endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2027] [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
Introduction and objectives
The indication for surgery to prevent embolism in infective endocarditis includes four clinical scenarios and three different echocardiographic measurements of the maximal vegetation diameter. These cut-off points are completely arbitrary and not evidence-based. Our hypothesis is that the vegetation diameter is not an appropriate surgical criterium. The goal of the study is to analyze the inter and intra-observer variability in this measurement and to compare the surgical indications agreement based on these parameters.
Methods
Two trained echocardiographers have measured the maximal vegetation diameter by transesophageal echocardiogram in 67 consecutive patients with definite infective endocarditis in an off-line workstation. The inter- and intra-observer variability was calculated by the interclass correlation coefficient and with the Bland-Altman analysis. The relationship between the strength of agreement for the cut-off points of 10 and 15 mm was also calculated.
Results
Intra and inter-observer interclass correlation coefficient in the measurement of the maximal longitudinal diameter of the vegetations were 0.872 (0.805–0.917) and 0.757 (0.642–0.839) respectively. The strength of agreement of the intra and inter-observer analysis for the cut-off point of 10 mm were 0.674 (0.485–0.862) and 0.533 (0.327–0.759). For the cut-off point of 15 mm they were 0.696 (0.530–0.862) and 0.475 (0.270–0.679).
Conclusions
The variability in the measurements of the maximal longitudinal diameter by transesophageal echocardiogram between two experimented echocardiographers is good. Nonetheless, surgical indications based on the cut-off points recommended in the European guidelines would have changed in an unacceptable high proportion of patients. Therefore, we suggest that these indications should be revised in the light of our results.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopez Diaz
- University Hospital Clinic (HCU), Valladolid, Spain
| | | | - M.T Sevilla
- University Hospital Clinic (HCU), Valladolid, Spain
| | - A Revilla
- University Hospital Clinic (HCU), Valladolid, Spain
| | | | - C Olmos
- Hospital Clinic San Carlos, Madrid, Spain
| | - R Ladron
- University Hospital Clinic (HCU), Valladolid, Spain
| | - I Gomez
- University Hospital Clinic (HCU), Valladolid, Spain
| | - G Cabezon
- University Hospital Clinic (HCU), Valladolid, Spain
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García-Granja PE, López J, Vilacosta I, Sarriá C, Domínguez F, Ladrón R, Olmos C, Sáez C, Vilches S, García-Arribas D, Cobo-Marcos M, Ramos A, Maroto L, Gómez I, Carrasco M, García-Pavía P, San Román JA. Predictive model of in-hospital mortality in left-sided infective endocarditis. Rev Esp Cardiol (Engl Ed) 2020; 73:902-909. [PMID: 31848066 DOI: 10.1016/j.rec.2019.11.003] [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] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Infective endocarditis (IE) is a complex disease with high in-hospital mortality. Prognostic assessment is essential to select the most appropriate therapeutic approach; however, international IE guidelines do not provide objective assessment of the individual risk in each patient. We aimed to design a predictive model of in-hospital mortality in left-sided IE combining the prognostic variables proposed by the European guidelines. METHODS Two prospective cohorts of consecutive patients with left-sided IE were used. Cohort 1 (n=1002) was randomized in a 2:1 ratio to obtain 2 samples: an adjustment sample to derive the model (n=688), and a validation sample for internal validation (n=314). Cohort 2 (n=133) was used for external validation. RESULTS The model included age, prosthetic valve IE, comorbidities, heart failure, renal failure, septic shock, Staphylococcus aureus, fungi, periannular complications, ventricular dysfunction, and vegetations as independent predictors of in-hospital mortality. The model showed good discrimination (area under the ROC curve=0.855; 95%CI, 0.825-0.885) and calibration (P value in Hosmer-Lemeshow test=0.409), which were ratified in the internal (area under the ROC curve=0.823; 95%CI, 0.774-0.873) and external validations (area under the ROC curve=0.753; 95%CI, 0.659-0.847). For the internal validation sample (observed mortality: 29.9%) the model predicted an in-hospital mortality of 30.7% (95%CI, 27.7-33.7), and for the external validation cohort (observed mortality: 27.1%) the value was 26.4% (95%CI, 22.2-30.5). CONCLUSIONS A predictive model of in-hospital mortality in left-sided IE based on the prognostic variables proposed by the European Society of Cardiology IE guidelines has high discriminatory ability.
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Affiliation(s)
- Pablo Elpidio García-Granja
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
| | - Fernando Domínguez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Raquel Ladrón
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
| | - Silvia Vilches
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Daniel García-Arribas
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Marta Cobo-Marcos
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Luis Maroto
- Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Itziar Gómez
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Pablo García-Pavía
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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García-Granja PE, López J, Vilacosta I, Sarriá C, Domínguez F, Ladrón R, Olmos C, Sáez C, Vilches S, García-Arribas D, Cobo-Marcos M, Ramos A, Maroto L, Gómez I, Carrasco M, García-Pavía P, San Román JA. Modelo predictivo de mortalidad hospitalaria en endocarditis infecciosa izquierda. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.04.010] [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: 10/24/2022]
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Garcia Granja P, Lopez J, Ladron R, Cabezon G, Vilacosta I, Dominguez F, Olmos C, Sarria C, Lopez I, Carrasco M, Garcia-Pavia P, San Roman A. Prognostic benefit of urgent cardiac surgery in left-sided infective endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2029] [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
Background
Cardiac surgery is required in approximately 50% of patients with left-sided infective endocarditis (IE) being a high-risk procedure specially during active phase of the disease.
Purpose
To evaluate the impact of cardiac surgery in the in-hospital mortality of left-sided IE.
Methods
We used a prospective cohort of consecutive patients with definite left-sided IE between 2000 and 2017 (n=1002). A predictive model of in-hospital mortality was derived by adding the variable cardiac surgery to the already published ENDOVAL score. The benefit of cardiac surgery was calculated with the mean difference between the risk of in-hospital mortality considering urgent surgery and considering no surgery for each patient.
Results
The predictive model showed good discriminative capacity with an area under the ROC curve of 0.861 (95% CI: 0.830 - 0.891) and a good calibration (p-value in the Hosmer-Lemeshow test of 0.353). Figure shows the in-hospital mortality prediction of each patient in case of no-surgery (orange), urgent surgery (yellow) or real decision (blue). Mean reduction of in-hospital mortality risk in case of surgery for patients with a theoretical risk of in-hospital mortality between 0–20% in absence of surgery was 3.2±1.6%. For patients with a theoretical risk between 20–40% in absence of surgery the mean reduction was 8.1±1.1%. For patients with a theoretical risk between 40–60% in absence of surgery the mean reduction was 10.7±0.3%. For patients with a theoretical risk between 60–80% in absence of surgery the mean reduction was 9.7±0.9%. For patients with a theoretical risk between 80–100% in absence of surgery the mean reduction was 4.6±2.1%.
Conclusion
Urgent cardiac surgery is a protective factor of in-hospital mortality for all patients with left-sided IE but especially for those with intermediate risk.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Gerencia Regional de Salud, Junta de Castilla y Leόn
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Affiliation(s)
| | - J.A Lopez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - R Ladron
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - G Cabezon
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | | | - F Dominguez
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Madrid, Spain
| | - C Sarria
- University Hospital De La Princesa, Madrid, Spain
| | - I Lopez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - M Carrasco
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - A San Roman
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
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Lopez Diaz J, Vilacosta I, Habib G, Miro J, Olmos C, Sarria C, Gonzalez-Juanatey C, Gonzalez-Juanatey J, Cuervo G, Cabezon G, Garcia-Granja P, Gomez I, San Roman J. The 3 noes right-sided infective endocarditis: a unrecognized type of right-sided endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2022] [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 “3 noes right-sided infective endocarditis” (3no-RSIE: no left-sided, no drug users, no cardiac devices) was depicted for the first time more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile.
Methods
Eight tertiary centers with surgical facilities participated in this study. Patients with right-sided endocarditis without left involvement, absence of antecedents of drug use and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analysed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis.
Results
A total of 100 patients (mean age 54.1±20 years, 65% male) with definite 3no-RSIE were included (16.7% of all the right-sided endocarditis of the series). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent, fever was the main manifestation at admission (85%). The microbiological profile is led by Staphylococci spp. Vegetations were detected in 92% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, p<0.001). Non community-acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died.
Conclusions
The clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery plays an important role in improving outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopez Diaz
- University Hospital Clinic (HCU), Valladolid, Spain
| | | | - G Habib
- APHM La Timone Hospital, Marseille, France
| | - J.M Miro
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Madrid, Spain
| | - C Sarria
- Hospital la Princesa, Madrid, Spain
| | | | | | - G Cuervo
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - G Cabezon
- University Hospital Clinic (HCU), Valladolid, Spain
| | | | - I Gomez
- University Hospital Clinic (HCU), Valladolid, Spain
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Zulet P, Carrión I, Islas F, Núñez-Gil I, Higueras J, Olmos C. Heartbreaking applause: an unexpected consequence of the COVID-19 crisis. REC: CardioClinics 2020. [PMCID: PMC7229935 DOI: 10.1016/j.rccl.2020.05.004] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Olmos C, Vilacosta I, López J, Sáez C, Anguita M, García-Granja PE, Sarriá C, Silva J, Álvarez-Álvarez B, Martínez-Monzonis MA, Castillo JC, Seijas J, López-Picado A, Peral V, Maroto L, San Román JA. Short-course antibiotic regimen compared to conventional antibiotic treatment for gram-positive cocci infective endocarditis: randomized clinical trial (SATIE). BMC Infect Dis 2020; 20:417. [PMID: 32546269 PMCID: PMC7298739 DOI: 10.1186/s12879-020-05132-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
Background Most serious complications of infective endocarditis (IE) appear in the so-called “critical phase” of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. Methods Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4–6 weeks). Sample: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. Intervention: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. Conclusions SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4–6 weeks). Trial registration ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019–003358-10.
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Affiliation(s)
- Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Valladolid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | | | - Cristina Sarriá
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Jacobo Silva
- Servicio de Cirugía Cardiaca, Hospital Universitario Central de Oviedo, Oviedo, Spain
| | - Belén Álvarez-Álvarez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María Amparo Martínez-Monzonis
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Carlos Castillo
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - José Seijas
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Amanda López-Picado
- Unidad de Investigación y Ensayos Clinicos. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Vicente Peral
- Servicio de Cardiología, Hospital Universitario de Son Espases, Palma de Mallorca, Spain
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Valladolid, Spain
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Olmos C. Comentario editorial a: Estimación de la mortalidad quirúrgica de la endocarditis infecciosa: comparación de las diferentes escalas específicas de cálculo de riesgo. Cirugía Cardiovascular 2020. [DOI: 10.1016/j.circv.2020.06.001] [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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Garcia-Arribas D, Olmos C, Higueras J, Marcos-Alberca P, de la Pedraja I, Garcia-Bouza M. Anomalous Origin of Left Coronary Artery with Intramural Aortic Course Causing Symptoms in a Teenaged Athlete. Tex Heart Inst J 2020; 47:165-167. [PMID: 32603454 DOI: 10.14503/thij-16-5771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Anomalous origin of the left coronary artery from the opposite sinus of Valsalva with an intramural aortic course is a rare congenital anomaly with a poor prognosis. We report the case of a 14-year-old soccer player who briefly lost consciousness while sprinting. He had exertional chest pain, syncope, ischemic changes on his electrocardiogram, and elevated cardiac troponin levels. Computed tomographic angiograms showed an anomalous origin of the left coronary artery from the right sinus of Valsalva and a course through the aortic wall toward the left coronary sinus. A surgically created neo-ostium in the left coronary sinus relieved the patient's ischemia, and he resumed playing soccer after cardiac rehabilitation.
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Affiliation(s)
- Daniel Garcia-Arribas
- Cardiovascular Institute, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Carmen Olmos
- Cardiovascular Institute, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Javier Higueras
- Cardiovascular Institute, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Pedro Marcos-Alberca
- Cardiovascular Institute, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Iñigo de la Pedraja
- Department of Radiology, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Monica Garcia-Bouza
- Cardiovascular Institute, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, 28040 Madrid, Spain
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Coma E, Medina M, Méndez L, Hermosilla E, Iglesias M, Olmos C, Calero S. Effectiveness of electronic point-of-care reminders versus monthly feedback to improve adherence to 10 clinical recommendations in primary care: a cluster randomized clinical trial. BMC Med Inform Decis Mak 2019; 19:245. [PMID: 31783854 PMCID: PMC6884876 DOI: 10.1186/s12911-019-0976-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/05/2018] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have analyzed the effectiveness of electronic reminder interventions to improve different clinical conditions, and most have reported a small to moderate effect. Few studies, however, have analyzed reminder systems targeting multiple conditions, and fewer still have compared electronic point-of-care reminders systems with other forms of feedback designed to improve delivery of care. METHODS We performed an unblinded cluster randomized clinical trial to compare the effectiveness of an electronic point-of-care reminder system with that of a well-established system providing monthly feedback on adherence to clinical recommendations. The control group received monthly feedback only while the intervention group received monthly feedback in addition to on-screen point-of-care reminders for 10 clinical conditions. The study targeted all physicians and nurses at the 283 primary care centers managed by the Institut Català de la Salut (approximately 6600 professionals). RESULTS Following exclusions and randomization, 132 primary care centers (328,728 patients with reminders) were assigned to the intervention group while 137 centers (317,117 patients with reminders) were randomized to the control group. A 20.6% improvement (OR 1.29, 95% CI: 1.25-1.34) in reminder resolution rates was observed in the intervention group. Results varied according to the clinical condition. The most effective reminder was screening for diabetic retinopathy (OR 1.51, 95% CI:1.46-1.57) while the least effective reminders were measurement of glycated hemoglobin (OR: 1.10, 95% CI: 1.07-1.13) and smoking cessation encouragement (OR 1.12, 95% CI: 1.09-1.16). CONCLUSIONS Electronic point-of-care reminders were more effective than the existing monthly feedback system at resolving the 10 clinical situations. However, more studies are needed to investigate the variations of the effect observed. TRIAL REGISTRATION Current Controlled Trials ISRCTN42391639, 08/10/2012. Retrospectively registered.
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Affiliation(s)
- Ermengol Coma
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Manuel Medina
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Leonardo Méndez
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Eduardo Hermosilla
- Sistema de Informació pel Desenvolupament d'Investigació en Atenció Primària (SIDIAP), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manuel Iglesias
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Spain
| | - Carmen Olmos
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Spain
| | - Sebastian Calero
- UGEAP Hospitalet Nord. DAP Delta. Institut Català de la Salut, Barcelona, Spain
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Freitas-Ferraz AB, Tirado-Conte G, Vilacosta I, Olmos C, Sáez C, López J, Sarriá C, Pérez-García CN, García-Arribas D, Ciudad M, García-Granja PE, Ladrón R, Ferrera C, Di Stefano S, Maroto L, Carnero M, San Román JA. Contemporary epidemiology and outcomes in recurrent infective endocarditis. Heart 2019; 106:596-602. [DOI: 10.1136/heartjnl-2019-315433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
ObjectiveRecurrent infective endocarditis (IE) is a major complication of patients surviving a first episode of IE. This study sought to analyse the current state of recurrent IE in a large contemporary cohort.Methods1335 consecutive episodes of IE were recruited prospectively in three tertiary care centres in Spain between 1996 and 2015. Episodes were categorised into group I (n=1227), first-IE episode and group II (n=108), recurrent IE (8.1%). After excluding six patients, due to lack of relevant data, group II was subdivided into IIa (n=87), reinfection (different microorganism), and IIb (n=15), relapse (same microorganism within 6 months of the initial episode).ResultsThe cumulative burden and incidence of recurrence was slightly lower in the second decade of the study (2006–2015) (7.17 vs 4.10 events/100 survivors and 7.51% vs 3.82, respectively). Patients with reinfections, compared with group I, were significantly younger, had a higher frequency of HIV infection, were more commonly intravenous drug users (IVDU) and prosthetic valve carriers, had less embolic complications and cardiac surgery, with similar in-hospital mortality. IVDU was found to be an independent predictor of reinfection (HR 3.92, 95% CI 1.86 to 8.28).In the relapse IE group, prosthetic valve endocarditis (PVE) and periannular complications were more common. Among patients treated medically, those with PVE had a higher relapse incidence (4.82% vs 0.43% in native valve IE, p=0.018). Staphylococcus aureus and PVE were independent predictors of relapse (HR 3.14, 95% CI 1.11 to 8.86 and 3.19, 95% CI 1.13 to 9.00, respectively) and in-hospital-mortality was similar to group I. Three-year all-cause mortality was similar in recurrent episodes compared with single episodes.ConclusionRecurrent IE remains a frequent late complication. IVDU was associated with a fourfold increase in the risk of reinfection. PVE treated medically and infections caused by S. aureus increased the risk of relapse. In-hospital and long-term mortality was comparable among groups.
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Travieso Gonzalez A, Islas F, Ferrandez Escarabajal M, Luque-Diaz TS, Palacios-Rubio J, Luaces M, Perez De Isla L, Olmos C. P6456Role of cardiac imaging in the prediction of ventricular arrythmias, heart failure and death in dilated non-ischemic cardiomyopathy with severe left ventricular systolic disfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1049] [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 and purpose
Dilated non-ischemic cardiomyopathy (DCM) is associated with an increased risk of cardiac events. Implantable Cardioverter Defibrillator (ICD) is recommended in DCM with severe left ventricular ejection fraction impairment, but the evidence of its usefulness is somewhat controversial. We evaluated the predictive value of myocardial fibrosis measured by cardiac magnetic resonance (CMR) and of global longitudinal strain (GLS) in the incidence of adverse cardiac events.
Methods
From 2009 to 2019, sixty-six patients with DCM were evaluated. CMR with a 1.5 Tesla scanner was performed, and the presence and extent of late gadolinium enhancement (LGE) was blindly assessed. GLS was measured using speckle-tracking 2D echocardiography. We examined the incidence of sustained ventricular arrhythmias (SVA, including appropriate anti-tachycardia pacing and shocks), admissions due to heart failure (HF) and all-cause mortality.
Results
62.1% of the patients were male, with a median age of 63.8 years. 50.0% had cardiac resynchronization therapy and 73.9% had ICD as primary prevention therapy. Median LVEF was 25.7%.
Median follow-up was 32 months. In that period, 10.6% of patients died, 25.8% had hospital admissions due to HF, and 9.2% had SVA. A burden of LGE over 14% was independently associated with higher risk of SVA (3.0% vs 19.2%, p=0.041). This cut-off value had a sensitivity of 83.3% and a negative predictive value of 97.0%. LGE was not associated with higher risk of HF admissions (27.3% vs 23.1%, p=0.731) or death (9.1% vs 11.5%, p=0.757).
On the other hand, GLS was not associated with higher risk of SVA (8.7% vs 4.55% for a cut-off value of −10.6%, p=0.577), HF admissions (26.1% vs 30.4%, p=0.743) or death (8.7% vs 8.7%, p=1.00).
Table 1. Main etiologies of DCM Causes N (%) Idiopathic 43 (65.2) Alcoholic 6 (9.1) Chemotherapy 4 (6.1) Non-compaction 4 (6.1) Familiar 3 (4.6) Thoracic radiotherapy 2 (3.0) Chagas disease 2 (3.0)
Conclusions
The burden of myocardial fibrosis measured by LGE is a high sensitive marker for the development of SVA. However, is not a predictive tool for HF admissions or all-cause mortality. GLS was not associated with the incidence of cardiac events in this population.
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Affiliation(s)
| | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - C Olmos
- Hospital Clinic San Carlos, Madrid, Spain
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Sáez C, Sarriá C, Vilacosta I, Olmos C, López J, García-Granja PE, Fernández C, de las Cuevas C, Reyes G, Domínguez L, San Román JA. "A contemporary description of staphylococcus aureus prosthetic valve endocarditis. Differences according to the time elapsed from surgery". Medicine (Baltimore) 2019; 98:e16903. [PMID: 31464922 PMCID: PMC6736462 DOI: 10.1097/md.0000000000016903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity.This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016.Fifty percent had a Charlson Index score >5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic stroke was not higher in anticoagulated patients. Twenty-seven percent were methicilin-resistant SA (MRSA). Fifteen of 31 had positive valve culture; it was related to surgery within first 24 hours. At diagnosis, 69% had vegetation (>10 mm in 75%), 21.8% perianular extension, and 20% prosthetic dehiscence. Forty-eight percent had persistent bacteremia, related to nonsurgical treatment. Perianular extension progressed in 18%. Surgery was performed in 35 episodes (12 with stroke). Eleven uncomplicated episodes were managed with medical therapy, 8 survived. In-hospital mortality was 55%, higher in episodes with hemorrhagic stroke (77.8% vs 52.2%, odds ratio 3.2 [0.62-16.55]). Early SAPVE was nosocomial (92%), presented as severe HF (54%), patients were diagnosed and operated on early, 38% died. In intermediate SAPVE (9 weeks-1 year) diagnosis was delayed (24%), patients presented with constitutional syndrome (18%), renal failure (41%), and underwent surgery >72 hours after indication; 53% died. Late SAPVE (>1 year) was related with health care, diagnosis delay, and 60% of deceases.Left SAPVE frequently affected patients with comorbidity and health care contact. Complications at diagnosis and absence of fever were frequent. Presence of MRSA was high. Positive valve culture was related to early surgery. Paravalvular extension was frequent; vegetations were large, but its absence at diagnosis was common. Some uncomplicated SAPVE episodes were safety treated with medical therapy. Surgery was feasible in patients with stroke. Mortality was high. There were differences in some clinical characteristics and in evolution according to the time elapsed from valve replacement. Prognosis was better in early SAPVE.
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Affiliation(s)
- Carmen Sáez
- Department of Medicine-Infectious diseases, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
| | - Cristina Sarriá
- Department of Medicine-Infectious diseases, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Javier López
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Elpidio García-Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina Fernández
- Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carmen de las Cuevas
- Department of Microbiology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Universidad Autónoma de Madrid, Spain
| | - Guillermo Reyes
- Department of Cardiac Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Universidad Autónoma de Madrid, Spain
| | - Lourdes Domínguez
- Department of Cardiology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Universidad Autónoma de Madrid, Spain
| | - Jose Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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