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Giovacchini J, Menale S, Scheggi V, Marchionni N. Pericardial anisakiasis: unravelling diagnostic challenges in an unprecedented extra-abdominal manifestation: a case report. Eur Heart J Case Rep 2024; 8:ytae093. [PMID: 38454962 PMCID: PMC10919384 DOI: 10.1093/ehjcr/ytae093] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Background Anisakis infects humans by consuming contaminated undercooked or raw fish, leading to gastric anisakiasis, gastro-allergic anisakiasis, or asymptomatic contamination. Although larvae usually die when penetrating the gastric tissue, cases of intra- and extra-abdominal spread were described. We report the first probable case of pericardial anisakiasis. Case summary A 26-year-old man presented to the emergency department because of progressive lower limb oedema and exertional dyspnoea. Two months prior, he had consumed raw fish without any gastrointestinal symptoms. The echocardiogram reported a circumferential pericardial effusion ('swinging heart') and mildly reduced left ventricular ejection fraction (LVEF). He was diagnosed with myopericarditis after a cardiac magnetic resonance. A fluorodeoxyglucose positron emission tomography scan revealed an intense pericardial metabolism. Blood tests exhibited persistent eosinophilia and mild elevation of Anisakis simplex IgE-as for past infestation. A pericardial drainage was performed, subsequently, serial echocardiograms revealed a spontaneous recovery of his LVEF. No autoimmune, allergic, or onco-haematologic diseases were identified. Based on a history of feeding with potentially contaminated raw fish and on long-lasting eosinophilia, we suspected a pericardial anisakiasis, despite a low but persistent titre of specific IgE. Albendazole was administered for 21 days, along with colchicine and ibuprofen for 2 months; pericardial effusion resolution and eosinophil normalization occurred two weeks after. Discussion We hypothesized that Anisakis larvae may have migrated outside the gastrointestinal tract, penetrating the diaphragm and settling in the pericardium, causing pericarditis and pericardial effusion. Clinicians should know that the pericardium may be another extra-abdominal localization of anisakiasis, beyond pleuro-pulmonary involvement.
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Affiliation(s)
- Jacopo Giovacchini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Silvia Menale
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
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2
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Ascione G, Scheggi V, Del Pace S. Diagnostic delays in modern medicine. A case report. Recenti Prog Med 2024; 115:95-96. [PMID: 38291936 DOI: 10.1701/4197.41844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Modern medicine has evolved toward ultra-specialization and sectoralization of medical specialties. This approach may provide an advantage for the quality of care of a single disease but implies the risk of not appropriately addressing comprehensive care. It may sometimes result in overall diagnostic delays due to the prescription of additional diagnostic tests, that could be appropriate considering the single specialist approach but do not consider the overall clinical context of the patient. We describe the case of a patient with multiple comorbidities, who experienced a multiple specialistic approach, without a holistic view.
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Affiliation(s)
- Giovanni Ascione
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Stefano Del Pace
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
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Scheggi V, Del Pace S, Fumagalli C, Meucci F, Nardi G, Di Muro FM, Menale S, Pisani E, Vitiello VS, Setti V, Valenti R, Cerillo A, Stefàno PL, Di Mario C, Marchionni N. Post-procedural fever after transcatheter aortic valve implantation: a retrospective single-centre study. J Hosp Infect 2024; 144:151-153. [PMID: 38029858 DOI: 10.1016/j.jhin.2023.10.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Affiliation(s)
- V Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
| | - S Del Pace
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - C Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - F Meucci
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - G Nardi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - F M Di Muro
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S Menale
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - E Pisani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - V S Vitiello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - V Setti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - R Valenti
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - A Cerillo
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - P L Stefàno
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - C Di Mario
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - N Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Scheggi V, Menale S, Tonietti B, Giovacchini J, Del Pace S, Zoppetti N, Alterini B, Stefàno PL, Marchionni N. Infective endocarditis in octogenarians. A retrospective study in a single, high-volume surgical centre. BMC Geriatr 2023; 23:659. [PMID: 37833642 PMCID: PMC10571254 DOI: 10.1186/s12877-023-04345-8] [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: 12/11/2022] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality. Little is known about the best management of elderly patients with IE. In these patients, surgery may be challenging. Our study aimed to describe IE's features in octogenarians and to identify the independent predictors of mortality, focusing on the prognostic impact of disability. METHODS We retrospectively analyzed 551 consecutive patients admitted to a single surgical centre with a definite diagnosis of non-device-related infective endocarditis; of these, 97 (17.6%) were older than 80 years. RESULTS In patients under eighty, males were mostly involved with a sex ratio exceeding 2:1. This ratio was inverted in older people, where the female gender represented 53.6% of the total. Enterococci (29.8 vs. 17.4%, p = 0.005) were significantly more frequent than in younger people. Comorbidities were more frequent in elderly patients; consequently, EuroSCORE II was higher (median ± IQR 16.4 ± 21.1 vs. 5.0 ± 10.3, p = 0.001). In octogenarians, IE was more frequently left-sided (97.9 vs. 89.8%, p = 0.011). Octogenarians were more often excluded from surgery despite indication (23.7 vs. 8.1%, p = 0.001) and had higher three-year mortality (45.3 vs. 30.6%, p = 0.005) than younger patients. In elderly patients, age did not independently predict mortality, while exclusion from surgery and a high grade of disability did. CONCLUSIONS Octogenarians with IE have specific clinical and microbiological characteristics. Older patients are more often excluded from surgery, and the overall prognosis is poor. Age per se should not be a reason to deny surgery, while disability predicts futility.
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Affiliation(s)
- Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Silvia Menale
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Tonietti
- Health Management Direction, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Giovacchini
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Del Pace
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Nicola Zoppetti
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Institute of applied physics "Nello Carrara" (IFAC), National Research Council, Florence, Italy
| | - Bruno Alterini
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pier Luigi Stefàno
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Andrei V, D'Ettore N, Scheggi V, di Mario C. Mesalazine-induced myopericarditis: a case series. Eur Heart J Case Rep 2023; 7:ytad424. [PMID: 37719002 PMCID: PMC10504860 DOI: 10.1093/ehjcr/ytad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
Background Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the gastrointestinal tract but can have multiorgan involvement. Mesalazine (5-ASA) is a key therapeutic agent in IBD. Mesalazine has rare but potentially life-threatening side effects such as cardiac injury. Case summary We present two cases of myopericarditis, documented also with cardiac magnetic resonance, that we attributed to 5-ASA hypersensitivity: the first is a young woman with ulcerative colitis who developed myopericarditis after the initiation of 5-ASA, with a good clinical response after discontinuation; the second is a 79-year-old man who developed symptoms of heart failure after the diagnosis of IBD and the introduction of 5-ASA. Discussion Mesalazine may cause rare but potentially life-threatening cardiac injury, which can be difficult to distinguish from acute IBD-induced cardiac inflammation.
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Affiliation(s)
- Valentina Andrei
- Division of Structural Interventional Cardiology, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
| | - Nicoletta D'Ettore
- Division of Structural Interventional Cardiology, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
| | - Valentina Scheggi
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Division of Cardiovascular and Perioperative Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
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Scheggi V, Bohbot Y, Tribouilloy C, Trojette F, Di Lena C, Philip M, Hubert S, Menale S, Zoppetti N, Del Pace S, Stefàno PL, Habib G, Marchionni N. Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations. Heart 2023:heartjnl-2023-322391. [PMID: 37147131 DOI: 10.1136/heartjnl-2023-322391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE The best strategy to manage patients with left-sided infective endocarditis (IE) and intermediate-length vegetations (10-15 mm) remains uncertain. We aimed to evaluate the role of surgery in patients with intermediate-length vegetations and no other European Society of Cardiology guidelines-approved surgical indication. METHODS We retrospectively enrolled 638 consecutive patients admitted to three academic centres (Amiens, Marseille and Florence University Hospitals) between 2012 and 2022 for left-sided definite IE (native or prosthetic) with intermediate-length vegetations (10-15 mm). We compared four clinical groups: medically (n=50) or surgically (n=345) treated complicated IE, medically (n=194) or surgically (n=49) treated uncomplicated IE. RESULTS Mean age was 67±14 years. Women were 182 (28.6%). The rate of embolic events on admission was 40% in medically treated and 61% in surgically treated complicated IE, 31% in medically treated and 26% in surgically treated uncomplicated IE. The analysis of all-cause mortality showed the lowest 5-year survival rate for medically treated complicated IE (53.7%). We found a similar 5-year survival rate for surgically treated complicated IE (71.4%) and medically treated uncomplicated IE (68.4%). The highest 5-year survival rate was observed in surgically treated uncomplicated IE group (82.4%, log-rank p<0.001). The analysis of the propensity score-matched cohort estimated an HR of 0.23 for uncomplicated IE treated surgically compared with medical therapy (p=0.005, 95% CI: 0.079 to 0.656). CONCLUSIONS Our results suggest that surgery is associated with lower all-cause mortality than medical therapy in patients with uncomplicated left-sided IE with intermediate-length vegetations even in the absence of other guideline-based indications.
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Affiliation(s)
- Valentina Scheggi
- Cardiovascular Medicine, Careggi University Hospital, Florence, Italy
| | - Yohann Bohbot
- Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Christophe Tribouilloy
- Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | | | | | - Mary Philip
- Cardiology, Marseille University Hospital, Marseille, France
| | | | - Silvia Menale
- Cardiology, Careggi University Hospital, Florence, Italy
| | - Nicola Zoppetti
- Istituto di Fisica Applicata "Nello Carrara", National Research Council, Sesto Fiorentino, Italy
| | | | | | - Gilbert Habib
- Cardiologie, Hospital La Timone, Insuffisance cardiaque et valvulopathie, Marseille, France
| | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence and Careggi Hospital, Florence, Italy
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Menale S, Scheggi V, Vanni F, Di Mario C. Cardiac sarcoidosis in a carrier of transthyretin gene mutation: a case report. Eur Heart J Case Rep 2023; 7:ytad058. [PMID: 36819882 PMCID: PMC9933939 DOI: 10.1093/ehjcr/ytad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/06/2022] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
Background Sarcoidosis is a rare multiorgan inflammatory disorder of unknown aetiology, characterized by the formation of non-caseating granulomas in the affected organs. Cardiac involvement is underrecognized and observed in up to 25% of cases in autopsy studies, and is associated with a high mortality rate, especially due to sudden cardiac death due to ventricular arrhythmias. Case summary A 41-year-old man well known to our hospital because of his father's diagnosis of cardiac amyloidosis, and carrier of transthyretin (TTR) gene mutation, was hospitalized following a resuscitated cardiac arrest. The patient was hospitalized a month before for a syncopal episode with demonstration of preserved left ventricular ejection fraction (LVEF) with akinetic basal septum at heart ultrasound and normal coronary. Chest computed tomography, performed in the emergency department, was significant for hilar lymphadenopathies and pulmonary nodules highly suggestive of sarcoidosis. A subsequent 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed multiorgan phlogistic involvement, including the myocardium. After the diagnosis of cardiac sarcoidosis, the patient was started on steroids therapy and underwent ICD implantation. A follow-up 18-FDG-PET showed a reduction of organs glucose uptake and a follow-up echo an improvement in LVEF. Despite that, he occurs occasional recording of repetitive ventricular arrhythmias and one appropriate ICD shock during the next 12 months. Discussion Cardiac sarcoidosis is an insidious disease. Its diagnosis can be challenging, with no specific finding in echocardiography. The best strategy would be multi-modality imaging involving both magnetic resonance imaging with late gadolinium enhancement and 18-FDG-PET, followed by biopsy to confirm the diagnosis. Multi-modality imaging should be further used to evaluate the response to treatment and assess prognosis. Since the patient was a known carrier of the TTR gene mutation, many efforts were made in order to come up with the correct diagnosis considering that both cardiac amyloidosis and cardiac sarcoidosis are non-ischaemic cardiomyopathy with systemic involvement.
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Affiliation(s)
- Silvia Menale
- Corresponding author. Tel: +39 3337336834, Fax: +39 (0)557946316,
| | - Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Florence, Italy,Cardiothoracovascular Department, Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Italy
| | - Francesco Vanni
- Division of Cardiovascular and Perioperative Medicine, Florence, Italy,Cardiothoracovascular Department, Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Italy
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Fumagalli C, Nardi G, Bonanni F, Credi G, Demola P, Carrabba N, Valenti R, Meucci F, Stefano P, Scheggi V, Di Mario C, Ungar A, Baldasseroni S, Marchionni N. 569 IMPACT OF FRAILTY ON VERY LONG-TERM OUTCOME IN PATIENTS UNDERGOING PERCUTANEOUS TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) IN A HIGH-FLOW REFERRAL CENTER: A PROSPECTIVE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.330] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Transcatheter strategies for aortic stenosis (AS) are a therapeutic option in older patients not amenable for open heart surgery. Guidelines recommend surgical scores like the Society of Thoracic Surgeons (STS) for risk stratification. However, the long-term predictive power of these scores in older patients is limited.
Purpose
To assess the impact of frailty status on the very long-term mortality in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center.
Methods
Consecutive patients >80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI).
The MPI is a three-level score used to stratify frailty and risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility, and risk of pressure sores, multimorbidity, polypharmacy and co-habitation).
Frailty was defined by an intermediate-high MPI. Patients were also analyzed by STS score (<4%: low risk; 4-8%: intermediate risk; >8%: high risk). All patients prospectively called at 1, 2 and 3 years from TAVI.
Results
Overall, 134 patients were referred for TAVI (mean age: 84±4 years; >90 years: 12%, women 67%). Average STS score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group.
After 3 years, 17 (12.7%) patients died, and 40 (29.9%) were hospitalized: 21 (15.7%) for cardiovascular complications (N=11 for acute heart failure, N=6 for major bleeding, N=4 for stroke). Four patients (2.9%) implanted a pacemaker. One patient (0.7%) required a de-novo intervention.
At Cox multivariable analysis, only frailty (MPI intermediate-high) was associated with mortality (HR 5.42, 95% C.I. 1.88-12.11, p=0.002) while a high STS score showed a trend towards higher mortality risk (HR 1.63, 95% C.I. 0.91-2.91, p=0.101). Overall, at Kaplan Meier survival analysis, patients considered fit (non-frail) were characterized by a better prognosis irrespective of STS score (<8 vs >8).
Conclusions
In a prospectively enrolled cohort of old TAVI candidates, frailty status was able to identify patients at higher risk of mortality irrespective of STS risk. Frailty assessment could be a useful tool, coupled with other scores, for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure.
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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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10
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Scheggi V, Menale S, Tonietti B, Giovacchini J, Bigiarini C, Del Pace S, Zoppetti N, Alterini B, Stefano PL, Marchionni N. Prognostic impact of cerebral embolism in patients with active infective endocarditis and therapeutic strategies. A retrospective real world study in a surgical centre. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1661] [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
Purpose
Infective endocarditis still has high mortality and invalidating complications, such as cerebral embolism. The best strategies to prevent and to manage neurologic complications remain uncertain. This study aimed to identify predictors of septic cerebral embolism and to evaluate the role of surgery in these patients, in a real-world surgical center.
Methods
We retrospectively analyzed 551 consecutive patients admitted to our department with a definite diagnosis of non-device-related infective endocarditis; of these, 126 (23%) presented a neurologic complication.
Results
Cerebral embolism was significantly more frequent in patients with large vegetations (p=0.001), mitral valve infection (p=0.001), and Staphylococcus aureus infection (p=0.025). At multivariable analysis, only vegetation length was an independent predictor of cerebral embolism (HR 1.057, 95% CI 1.025–1.091, p 0.001), with a best predictive threshold of 10 mm at ROC curve analysis (AUC 0.54, p=0.001). Patients with neurologic complications were more often excluded from surgery despite an indication to it (16% vs 8%, p=0.001). If eligible, they were treated within two weeks from diagnosis in similar proportion as patients without cerebral embolism with similar survival rate. Predictors of mortality were hemorrhagic lesions (p=0.018), a GCS<14 (p=0.001) or a severe degree of disability (p=0.001) at presentation. The latter was the only independent predictor of mortality at multivariable analysis (HR 2.3, 95% CI 1.43–3.80, p=0.001).
Conclusions
The present study highlights the prognostic value of clinical functional presentation and the safety of cardiac surgery, when feasible, in patients with septic cerebral embolism.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital (AOUC), Division of Cardiovascular and Perioperative Medicine , Florence , Italy
| | - S Menale
- Careggi University Hospital (AOUC), Division of General Cardiology , Florence , Italy
| | - B Tonietti
- Careggi University Hospital (AOUC) , Florence , Italy
| | - J Giovacchini
- Careggi University Hospital (AOUC), Division of General Cardiology , Florence , Italy
| | - C Bigiarini
- Careggi University Hospital (AOUC), Division of Cardiovascular and Perioperative Medicine , Florence , Italy
| | - S Del Pace
- Careggi University Hospital (AOUC), Division of General Cardiology , Florence , Italy
| | - N Zoppetti
- Institute of applied physics “Nello Carrara” (IFAC), National Research Council, Florence, Italy , Florence , Italy
| | - B Alterini
- Careggi University Hospital (AOUC), Division of Cardiovascular and Perioperative Medicine , Florence , Italy
| | - P L Stefano
- Careggi University Hospital (AOUC), Division of Cardiac Surgery , Florence , Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Division of General Cardiology , Florence , Italy
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Scheggi V, Righi L, Moschi G, Mechi MT, Marchionni N. The impact of co-working with an Internist in a high-speciality division of cardiology in a third-level centre. Experience with a new organization model. Eur J Intern Med 2022; 104:122-124. [PMID: 35803830 DOI: 10.1016/j.ejim.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
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12
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Menale S, Scheggi V, Giovacchini J, Marchionni N. Persistent respiratory failure after SARS-CoV-2 infection: The role of dual energy computed tomography. A case report. Radiol Case Rep 2022; 17:3179-3184. [PMID: 35784783 PMCID: PMC9236780 DOI: 10.1016/j.radcr.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background: COVID-19 disease is often complicated by respiratory failure, developing through multiple pathophysiological mechanisms, with pulmonary embolism (PE) and microvascular thrombosis as key and frequent components. Newer imaging modalities such as dual-energy computed tomography (DECT) can represent a turning point in the diagnosis and follow-up of suspected PE during COVID-19. Case presentation: A 78-year-old female presented to our internal medicine 3 weeks after initial hospitalization for COVID-19 disease, for recrudescent respiratory failure needing oxygen therapy. A computed tomography (CT) lungs scan showed a typical SARSCoV-2 pneumonia. Over the following 15 days, respiratory function gradually improved. Unexpectedly, after 21 days from symptom onset, the patient started complaining of breath shortening with remarkable desaturation requiring high-flow oxygen ventilation. CT pulmonary angiography and transthoracic echocardiography were negative for signs of PE. Thereby, Dual-energy CT angiography of the lungs (DECT) was performed and detected diffuse peripheral microembolism. After 2 weeks, a second DECT was performed, showing a good response to the anticoagulation regimen, with reduced extent of microembolism and some of the remaining emboli partially recanalized. Discussion: DECT is an emerging diagnostic technique providing both functional and anatomical information. DECT has been reported to produce a much sharper delineation of perfusion defects than pulmonary scintigraphy, using a significantly lower equivalent dose of mSv. We highlight that DECT is particularly useful in SARS-Cov-2 infection, in order to determine the predominant underlying pathophysiology, particularly when respiratory failure prolongs despite improved lung parenchymal radiological findings
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13
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Scheggi V, Castellini G, Vanni F, Menale S, Filardo C, Gironi V, Rinaldi A, Zoppetti N, Alterini B, Ricca V, Marchionni N. Echocardiographic Abnormalities in Adults With Anorexia Nervosa. Am J Cardiol 2022; 175:152-157. [PMID: 35597626 DOI: 10.1016/j.amjcard.2022.03.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 01/30/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/01/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric disorder that may lead to cardiac complications. The objective of this study was to evaluate global and regional longitudinal strain changes in patients affected by AN as an early marker of myocardial damage. We prospectively enrolled 48 consecutive patients with AN and 44 age-matched and gender-matched healthy controls. In all subjects, we performed echocardiography, including global longitudinal strain (GLS) measurement. A subset of 33 patients with AN had further echocardiographic examinations during the follow-up. Compared with healthy controls, patients with AN had a greater prevalence of pericardial effusion (9 of 48 vs 0 of 44, p = 0.003), a smaller left ventricular mass (63 ± 15 vs 99 ± 30 g, p < 0.001), a lower absolute value of GLS (-18.9 ± 2.8 vs -20.2 ± 1.8%, p = 0.010) and of basal LS (-15.4 ± 6.0 vs -19.4 ± 2.6%, p < 0.001). The bull's eye mapping showed a plot pattern with blue basal areas in 18 of 48 patients with AN versus 1 of 44 controls (p < 0.001). During the follow-up, of 13 patients with blue areas in the first bull's eye mapping, 11 recovered completely, and of 20 patients with a red bull's eye at the first examination, none presented blue areas at the second one. In conclusion, GLS is significantly altered in patients with AN, and a basal blue pattern on bull's eye mapping identifies more severe cases. These changes seem to be reversible.
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Affiliation(s)
| | | | - Francesco Vanni
- Division of General Cardiology, Cardiothoracic Vascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Silvia Menale
- Division of General Cardiology, Cardiothoracic Vascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | | | | | | | - Nicola Zoppetti
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council, Sesto Fiorentino, Italy
| | | | | | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracic Vascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
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14
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Scheggi V, Menale S, Tonietti B, Bigiarini C, Giovacchini J, Del Pace S, Zoppetti N, Alterini B, Stefàno PL, Marchionni N. Impact of septic cerebral embolism on prognosis and therapeutic strategies of infective endocarditis: a retrospective study in a surgical centre. BMC Infect Dis 2022; 22:554. [PMID: 35715766 PMCID: PMC9206378 DOI: 10.1186/s12879-022-07533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infective endocarditis still has high mortality and invalidating complications, such as cerebral embolism. The best strategies to prevent and manage neurologic complications remain uncertain. This study aimed to identify predictors of cerebral septic embolism and evaluate the role of surgery in these patients in a real-world surgical centre. Methods We retrospectively analyzed 551 consecutive patients admitted to our department with a definite diagnosis of non-device-related infective endocarditis; of these, 126 (23%) presented a neurologic complication. Results Cerebral embolism was significantly more frequent in patients with large vegetations (p = 0.004), mitral valve infection (p = 0.001), and Staphylococcus aureus infection (p = 0.025). At multivariable analysis, only vegetation length was an independent predictor of cerebral embolism (HR per unit 1.057, 95% CI 1.025–1.091, p 0.001), with a best predictive threshold of 10 mm at ROC curve analysis (AUC 0.54, p = 0.001). Patients with neurologic complications were more often excluded from surgery despite an indication to it (16% vs 8%, p = 0.001). If eligible, they were treated within two weeks from diagnosis in similar proportions as patients without cerebral embolism with a similar survival rate. Predictors of mortality were hemorrhagic lesions (p = 0.018), a GCS < 14 (p = 0.001) or a severe degree of disability (p = 0.001) at presentation. The latter was the only independent predictor of mortality at multivariable analysis (HR 2.3, 95% CI 1.43–3.80, p = 0.001). Conclusions The present study highlights the prognostic value of functional presentation and the safety of cardiac surgery, when feasible, in patients with cerebral septic embolism.
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Affiliation(s)
- Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Florence, Italy. .,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
| | - Silvia Menale
- Division of General Cardiology, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Barbara Tonietti
- Health Management Direction, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Costanza Bigiarini
- Division of Cardiovascular and Perioperative Medicine, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Jacopo Giovacchini
- Division of General Cardiology, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Stefano Del Pace
- Division of General Cardiology, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Nicola Zoppetti
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council, Florence, Italy
| | - Bruno Alterini
- Division of Cardiovascular and Perioperative Medicine, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Pier Luigi Stefàno
- Division of Cardiac Surgery, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
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15
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Scheggi V, Merilli I, Ceschia N, Vanni F, Alterini B, Stefano PL, Marchionni N. Infective endocarditis in octogenarians: a retrospective study in a single surgical center. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.189] [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
Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality. The EURO-ENDO registry reported a mean age of 59.25 ± 18.03 years; 46.3% of patients were over 65 and 12.0% over 80 years. Little is known about the best management of elderly patients with IE. In these patients, surgery may be challenging.
Purpose
We aimed to determine the clinical and echographic characteristics, the therapeutic strategy, and the outcome of IE in octogenarians.
Method
We retrospectively included in the analysis 457 consecutive patients with definite active IE in a single surgical centre. Descriptive statistics are reported as mean ± standard deviation (SD) or median ± interquartile range (IQR) for continuous variables with normal and non-normal distribution and as frequencies and percentages for categorical variables. Between-groups comparisons were assessed by Student’s t-test, Mann-Whitney U test, Kruskal-Wallis, or chi-square test, as appropriate. Univariate long-term survival was analysed by the Kaplan-Meier method.
Results
In our cohort, octogenarians were 17% of the whole population (N = 77). In patients under the age of eighty, males were mostly involved with a sex ratio exceeding 2:1. This ratio was inverted in older people, where the female gender represented 57% of the total (0.001). Staphylococcus aureus (10.4 vs 20.5%, p =0.038) and Enterococci (29.9 vs 16.3%, p =0.008) were significantly less and more frequent than in younger people, respectively. Comorbidities were more frequent in elderly patients, such as hypertension (80.5 vs 53.2%, p = 0.001), dyslipidaemia (42.7 vs 27.3%, p = 0.008), and history of cancer (29.9 vs 19.2%, p = 0.036). Consequently, EUROSCORE II was higher (median ± IQR 19.18 ± 19.0 vs 11.9 ± 5.7, p = 0.001). In octogenarians, IE was more frequently left-sided (98.7 vs 89.2, p = 0.009) and complicated less often with peripheral embolism (31.2 vs 43.9%, p = 0.038). We found no differences between the two groups for the type of infected valve (native or prosthetic), the severity of valve dysfunction, paravalvular extension, and vegetation length. Octogenarians were more often excluded from surgery despite indication (19.5 vs 7.7%, p = 0.016) and had higher thirty-day (11.7 vs 7.9%, p = 0.001) and three-year (45 vs 30%, p = 0.001) mortality than younger patients.
Conclusions
Octogenarians represent a considerable proportion of overall cases of IE, with specific clinical and microbiological characteristics. Older patients are more often excluded from surgery, and the overall prognosis is poor. Abstract Figure.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Merilli
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Ceschia
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - F Vanni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - PL Stefano
- Careggi University Hospital, Cardiac surgery, Florence, Italy
| | - N Marchionni
- Careggi University Hospital, Cardiac surgery, Florence, Italy
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16
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Scheggi V, Vanni F, Filardo C, Rinaldi A, D"anna G, Giammetti S, Castellini G, Alterini B, Marchionni N, Ricca V. The starving heart. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.024] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Anorexia Nervosa (AN) is a psychiatric disorder that can lead to cardiac complications, especially in severely malnourished patients. Cardiovascular involvement includes autonomic dysfunction (increased vagal tone, bradycardia, orthostatic hypotension, syncope), arrhythmias, pericardial effusion, heart failure and sudden death. A few studies have examined the echocardiographic abnormalities secondary to AN, reporting mainly a decreased cardiac mass and an increased incidence of pericardial effusion. No previous studies examined the changes of Global Longitudinal Strain (GLS), which has been shown to be an early marker of myocardial damage in other subsets.
Purpose
This study aimed to characterize echocardiographic abnormalities in AN, and to assess impairment of global and regional longitudinal strain (LS) and its clinical value in this context.
Methods
We prospectively enrolled 42 consecutive patients (1 male) admitted to a highly specialized AN unit between November 2020 and July 2021 with AN (Mental Disorders, 4th Edition-DSM IVr). We also selected 34 healthy controls, matched for age and sex. In all subjects, we reported the cardiac frequency, systolic and diastolic blood pressure, blood examinations, and we performed an echocardiography, including GLS measurement. Eighteen patients were treated with enteral or parenteral feeding. A subset of 26 AN patients performed a second echocardiography after one month of follow up; 14 of them received forced feeding.
Results
Compared with healthy subjects, AN patients had significantly lower albumin levels (45.1 ± 10.3 vs 66.0 ± 4.8 mg/dl, p = 0.031), lower FT3 levels (3.7 ± 1.0 vs 7.9 ± 6.4 pg/mL, p = 0.001), higher FT4 levels (13.8 ± 1.8 vs 9.6 ± 8.1 pg/mL, p = 0.008), a lower cardiac frequency (63 ± 18 vs 73 ± 12 bpm, p = 0.004), a higher incidence of pericardial effusion (9/42 vs 0/34, p = 0.008), a lower myocardial mass (62.3 ± 15.0 vs 98.5 ± 28.5 g, p < 0.001), a lower absolute value of GLS (-18.8 ± 2.8 vs -20.3 ± 2.0 %, p = 0.014) and basal LS (-15.4 ± 6.1 vs -19.6 ± 2.8 %, p < 0.001). The bull’s eye mapping showed a plot pattern with blue basal areas in 17/42 AN patients vs 1/34 healthy subjects (p < 0.001). The 17 anorexic patients with a blue basal pattern needed forced feeding in a higher proportion (11/17 vs 7/25, p = 0.018) and presented more frequently amenorrhea (14/17 vs 11/25, p = 0.046). During the follow up (26 AN patients performed a second echocardiography), of 13 patients with blue areas in the first bull’s eye mapping, 11 recovered a completely red pattern, and of 13 patients with a red bull’s eye in the first examination, no one presented blue areas on the second one.
Conclusions
GLS is significantly altered in AN patients and a basal blue pattern on bull’s eye mapping individuates more severe cases. These changes seem to be reversible (Figure 1), although further studies are necessary to understand which factors influence this pattern besides BMI. Abstract Figure 1
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - F Vanni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - C Filardo
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - A Rinaldi
- Careggi University Hospital, Psychiatry, Florence, Italy
| | - G D"anna
- Careggi University Hospital, Psychiatry, Florence, Italy
| | - S Giammetti
- Careggi University Hospital, Psychiatry, Florence, Italy
| | - G Castellini
- Careggi University Hospital, Psychiatry, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Marchionni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - V Ricca
- Careggi University Hospital, Psychiatry, Florence, Italy
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Mazzoni C, Scheggi V, Mariani T. Cardiac involvement in Behçet disease presenting as non-bacterial thrombotic endocarditis: A case report. J Cardiol Cases 2022; 24:157-160. [PMID: 35059048 DOI: 10.1016/j.jccase.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/21/2020] [Revised: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 01/09/2023] Open
Abstract
Behçet disease (BD) is a form of widespread vasculitis that involves both arteries and veins. Cardiac involvement in BD is exceedingly rare and can present as a form of non-bacterial- thrombotic-endocarditis (NBTE). A 54-year-old man with Behçet disease was admitted to our hospital after presenting with abdominal pain and fever. He had been recently discharged from a hospital in another country with the diagnosis of infective endocarditis of the mitral valve and mycotic embolization to the superior mesenteric artery. At presentation, oral and genital ulcers were present, raising the suspicion of a flare of BD. Transesophageal echocardiography showed a small vegetation on the anterior leaflet of the mitral valve. Blood cultures results were negative. Computed tomography of the abdomen showed extensive inferior vena cava thrombosis. The aneurysm and thrombotic phenomena were interpreted as related to BD: the vegetation on the mitral valve was diagnosed as NBTE of which BD is a recognized cause. With corticosteroid and anticoagulant therapy, the patient's symptoms steadily improved. NBTE is a rare manifestation of BD; differential diagnosis with infective endocarditis can be challenging and should be focused on identifying predisposing conditions. The mainstay of treatment in NBTE is medical therapy with anticoagulation and treatment of the underlying disease. <Learning objective: Cardiac involvement in the setting of Behçet Disease (BD) is rare and several different manifestations are described (intracardiac thrombus, non-infective endocarditis, myocarditis, pericarditis, endomyocardial fibrosis, coronary arteritis). Non-bacterial thrombotic endocarditis (NBTE) is also a rare finding which can happen in the setting of BD. Its prevalence is unknown and evidence is derived only from scarce case reports.The role of BD as a potential cause of NBTE must be acknowledged to avoid potential misdiagnosis.>.
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Affiliation(s)
- Carlotta Mazzoni
- Division of Cardiology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, Florence 50133, Italy
| | - Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, Florence 50133, Italy
- Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
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18
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D'Ettore N, Scheggi V, Alterini B, Marchionni N. Cerebral lesions in hematological malignancies: a case report. J Med Case Rep 2021; 15:603. [PMID: 34924018 PMCID: PMC8684816 DOI: 10.1186/s13256-021-03196-4] [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: 02/23/2021] [Accepted: 11/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy is a rare central nervous system disease, resulting from reactivation of latent John Cunningham virus. Monoclonal antibodies have recently become a relevant risk factor for developing progressive multifocal leukoencephalopathy.
Case summary We report the case of a 62-year-old Caucasian man who was admitted to our department in June 2020 because of right homonymous hemianopia. Magnetic resonance imaging findings were first interpreted as an intracranial relapsed lymphoma, so brain biopsy was performed, but no neoplastic cell was found. Histological sample only showed a large number of macrophages. The patient came back to our attention because of the worsening of neurological symptoms. A second magnetic resonance imaging showed widespread lesions suggestive of a demyelinating process. John Cunningham virus DNA was detected by polymerase chain reaction assay of the cerebrospinal fluid (over 9 million units/μL). The patient was treated supportively, but the outcome was poor. Discussion A multidisciplinary assessment should be performed for differential diagnosis of cerebral lesions in hematologic malignancies. Progressive multifocal leukoencephalopathy should be suspected in cases of subacute neurological symptoms and imaging findings consistent with it, especially if the patient received immunosuppressive or immunomodulatory drugs.
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Affiliation(s)
- Nicoletta D'Ettore
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50133, Florence, Italy.
| | - Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50133, Florence, Italy
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Abstract
INTRODUCTION Drug-induced thrombotic microangiopathy (DITMA) is an acquired condition resulting from exposure to a drug that induces the formation of platelet-rich thrombi in small arterioles or capillaries secondary to drug-dependent antibodies or direct tissue toxicity. Carfilzomib is a selective proteasome inhibitor approved to treat selected patients with Multiple Myeloma (MM). It is one of the drugs with the strongest evidence for a causal association with non-antibody-mediated DITMA. CASE REPORT A 75-year-old man presented to the emergency department for the outbreak of vomit, asthenia, oliguria and dark stool emission. He was recently diagnosed with multiple myeloma, treated with lenalidomide, dexamethasone and carfilzomib. Laboratory exams were significant for microangiopathic haemolytic anaemia, thrombocytopenia and new-onset renal failure. ADAMTS-13 levels were in range, and no infectious signs were found both in blood nor in stool test. MANAGEMENT & OUTCOME A carfilzomib induced thrombotic microangiopathy was soon suspected. Thus, since daily haemodialysis and supportive care did not seem to get a fast enough recovery, the patient was treated with eculizumab with a good general outcome. DISCUSSION Drug-induced thrombotic microangiopathy is a rare and often life-threatening acquired condition whose diagnosis can be challenging and whose therapy is not always limited to supportive treatment and drug avoidance. Carfilzomib, along with other proteasome inhibitors, is one of the described potential drugs which can trigger such a manifestation.
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Affiliation(s)
- Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Irene Merilli
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Edoardo Cesaroni
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Bruno Alterini
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
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Fumagalli C, Nardi G, Demola P, Meucci F, Valenti R, Scheggi V, Carrabba N, Mario CD, Baldasseroni S, Ungar A, Marchionni N. 775 Impact of frailty on medium-term follow-up in patients undergoing transcatheter aortic valve implantation in a high flow referral centre with high volumes. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.018] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. To assess the impact of frailty status on a composite endpoint comprising all-cause death and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care centre.
Methods and results
Consecutive patients >80 years referred to TAVI from January to December 2019 at our institution were screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the multidimensional prognostic index (MPI). Physical function was evaluated by the short physical performance battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB <6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy, and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Overall, 134 patients were referred for TAVI (mean age: 84 ± 4 years; >90 years: 12%, women 67%). The STS risk score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3 ± 3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R = 0.31, P = 0.01, MPI R = 0.29, P = 0.03, Figure 1A and B). At 1 year, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N = 6(4.5%); stroke: N = 4 (3.0%); re-do: N = 1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs. low risk: HR: 2.9, 95% CI: 1.1–6.8, P = 0.031, Figure 1C), while no association with STS (P = 0.332) was found.
Conclusions
In a prospective cohort of TAVI candidates, frailty stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. 120 Figure
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21
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Cosyns B, Roosens B, Lancellotti P, Laroche C, Dulgheru R, Scheggi V, Vilacosta I, Pasquet A, Piper C, Reyes G, Mahfouz E, Kobalava Z, Piroth L, Kasprzak JD, Moreo A, Faucher JF, Ternacle J, Meshaal M, Maggioni AP, Iung B, Habib G. Cancer and Infective Endocarditis: Characteristics and Prognostic Impact. Front Cardiovasc Med 2021; 8:766996. [PMID: 34859076 PMCID: PMC8631931 DOI: 10.3389/fcvm.2021.766996] [Citation(s) in RCA: 3] [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: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The interplay between cancer and IE has become of increasing interest. This study sought to assess the prevalence, baseline characteristics, management, and outcomes of IE cancer patients in the ESC EORP EURO-ENDO registry. Methods: Three thousand and eighty-five patients with IE were identified based on the ESC 2015 criteria. Three hundred and fifty-nine (11.6%) IE cancer patients were compared to 2,726 (88.4%) cancer-free IE patients. Results: In cancer patients, IE was mostly community-acquired (74.8%). The most frequently identified microorganisms were S. aureus (25.4%) and Enterococci (23.8%). The most frequent complications were acute renal failure (25.9%), embolic events (21.7%) and congestive heart failure (18.1%). Theoretical indication for cardiac surgery was not significantly different between groups (65.5 vs. 69.8%, P = 0.091), but was effectively less performed when indicated in IE patients with cancer (65.5 vs. 75.0%, P = 0.002). Compared to cancer-free IE patients, in-hospital and 1-year mortality occurred in 23.4 vs. 16.1%, P = 0.006, and 18.0 vs. 10.2%; P < 0.001, respectively. In IE cancer patients, predictors of mortality by multivariate analysis were creatinine > 2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). Conclusions: Cancer in IE patients is common and associated with a worse outcome. This large, observational cohort provides new insights concerning the contemporary profile, management, and clinical outcomes of IE cancer patients across a wide range of countries.
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Affiliation(s)
- Bernard Cosyns
- Centrum Voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,In vivo Cellular and Molecular Imaging (ICMI) Center, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bram Roosens
- Centrum Voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Patrizio Lancellotti
- Cardiology Department, University Hospital Centre, Centre Hospitalier Universitaire (CHU) Sart Tilman, Liège, Belgium
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Antibes, France
| | - Raluca Dulgheru
- Cardiology Department, University Hospital Centre, Centre Hospitalier Universitaire (CHU) Sart Tilman, Liège, Belgium
| | - Valentina Scheggi
- Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW), Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Graciela Reyes
- Echo Lab Department, Hospital de Alta Complejidad en red El Cruce, Florencio Varela, Buenos Aires, Argentina
| | - Essam Mahfouz
- Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - Zhanna Kobalava
- Department of Cardiology, Rossiyskiy Universitet Druzhby Narodov (RUDN) University Moscow, Moscow, Russia
| | - Lionel Piroth
- Infectious Diseases Department, University Hospital, INSERM CIC1432, University of Burgundy, Dijon, France
| | | | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jean-François Faucher
- CHU Limoges, Department of Infectious Diseases and Tropical Medicine, Limoges France INSERM, U1094, Limoges, France
| | - Julien Ternacle
- Cardiology Department, Henri Mondor Hospital, SOS Endocardites, DHU ATVB, INSERM U955 Team 8, Université Paris-Est Créteil, Créteil, France.,Fellow Equipe, Team du Dr Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute Université Laval, Quebec City, QC, Canada
| | - Marwa Meshaal
- Cardiology Department, Kasr Al Ainy, Cairo University, Cairo, Egypt
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Antibes, France.,Maria Cecilia Hospital, Gruppo Villa Maria (GVM) Care & Research, Cotignola, Italy
| | - Bernard Iung
- Bichat Hospital, APHP, DHU Fire, Paris Diderot University, Paris, France
| | - Gilbert Habib
- AP-HM, La Timone Hospital, Cardiology Department, Marseille, France.,Aix Marseille University, IRD, AP-HM, MEPHI, IHU-Mediterranean Infection, Marseille, France
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22
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Fumagalli C, Blandina A, Nardi G, Campicelli S, Bandini G, Marchetti F, Demola P, Meucci F, Scheggi V, Baldasseroni S, Carrabba N, Di Mario C, Ungar A, Marchionni N. Impact of frailty status on medium-term follow up in patients undergoing percutaneous transcatheter aortic valve implantation in a high-flow referral center with high procedural volumes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1662] [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
Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Current guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients.
Purpose
To assess the impact of frailty status on a composite endpoint comprising mortality and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center.
Methods
Consecutive patients >80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI). Physical function was evaluated by the Short Physical Performance Battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB <6 is an established strong predictor of mortality and disability.
The MPI is a three-level score used to stratify risk of mortality (low, intermediate or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy and co-habitation).
Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up.
Results
Overall, 134 patients were referred for TAVI (mean age: 84±4 years; >90 years: 12%, women 67%). The average STS risk score was 4.6±3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R=0.31, p=0.01, MPI R=0.29, p=0.03, Figure Panel A and B).
At 12 months, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N=6 (4.5%); stroke: N=4 (3.0%); re-do: N=1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs low risk: HR 2.9, 95% CI 1.1–6.8, p=0.031, Figure 1 Panel C), while no association with STS (p=0.332) was found.
Conclusions
In a prospectively enrolled cohort of TAVI candidates, frailty indices stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- C Fumagalli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Blandina
- Careggi University Hospital, Florence, Italy
| | - G Nardi
- Careggi University Hospital, Florence, Italy
| | | | - G Bandini
- Careggi University Hospital, Florence, Italy
| | - F Marchetti
- Careggi University Hospital, Florence, Italy
| | - P Demola
- Careggi University Hospital, Florence, Italy
| | - F Meucci
- Careggi University Hospital, Florence, Italy
| | - V Scheggi
- Careggi University Hospital, Florence, Italy
| | | | - N Carrabba
- Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Careggi University Hospital, Florence, Italy
| | - A Ungar
- Careggi University Hospital, Florence, Italy
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Scheggi V, Ceschia N, Vanni F, Merilli I, Sottili E, Alterini B, Marchionni N, Stefano PL. Injection drug use infective endocarditis: clinical features and therapeutic challanges. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1711] [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
Injection drug use (IDU) is a known risk factor for infective endocarditis (IE) and is associated with frequent recurrences, but its prognostic impact is still debated. Moreover, the potential futility of surgery in this population is an unsolved matter.
Purpose
We aimed to determine the clinical characteristics, the therapeutic strategy, and the prognostic impact of injection drug use IE (IDUIE).
Method
We retrospectively included in the analysis 454 consecutive episodes of definite active IE admitted in a single surgical centre from January 2012 to December 2020; 14 out of them where a subsequent infective episode of the same patient.
Results
IDUIE cases were 63 (13.8%), without significant proportional differences over time. IDUIE patients were significantly younger (43.95±10.12 vs 67.84±13.33, p 0.00) and presented fewer comorbidities (p<0.001). They were admitted with a first episode of IE only in 60.3% of cases vs 92.8% of non-IDU (p<0.001). Embolism was present at admission in a higher percentage (60.3 vs 38.4%, p<0.001). IDUIE was more frequently associated with spondylodiscitis (15.9 vs 7.4%, p=0.026). The infection was less frequently left-sided than in non-IDU patients (57.1 vs 97.2%, p<0.001) and was more often polimicrobic (12.7 vs 4.9%, p=0.015). Most patients were positive for Staphylococcus aureus (54.0 vs 12.8%, p<0.001), while Streptococci were significantly less frequent in patients with IDUIE (11 vs 25%, p=0.015). The proportion of patients undergoing surgery was similar among the two groups (85.5 vs 78.8%, NS). IDUIE patients treated medically for absence of surgical indication had a better survival than patients undergoing surgery for complicated IE (p<0.001). IDUIE was associated with a higher proportion of relapse during follow-up (28.3 vs 3.3%, p<0.001). It was not associated with higher mortality (Figure 1) but was an independent predictor of mortality in multivariable analysis including age (HR per unit 1.048, 95% CI 1.038–1.063, p=0.00) and drug abuse (HR 3.2, 95% CI 1.8–5.6, p=0.00; Figure 2). Among IDUIE patients, we did not find predictors of futility of surgery, not even multiple relapses.
Conclusions
IDUIE represents a considerable proportion of overall cases of IE, mainly affecting young people. Staphylococcus aureus is the most common microbiologic agent. IDUIE is not associated with higher mortality but drug abuse is an independent predictor of mortality. Considering that patient with uncomplicated IE treated medically have a better prognosis, we should reserve surgery to patients with a strict indication for it. On the other hand, since there are no predictors of futility of surgery, all patients with a complicated IE should undergo surgery without delay. The main determinant of prognosis in these patients is not IE but drug abuse itself. For this reason, increased focus on addiction treatment following hospital discharge is mandatory to improve long term prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Ceschia
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - F Vanni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Merilli
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - E Sottili
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Marchionni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P L Stefano
- Careggi University Hospital, Cardiac surgery, Florence, Italy
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Scheggi V, Vanni F, Ceschia N, Merilli I, Sottili E, Alterini B, Stefano PL, Marchionni N. Double-valve infective endocarditis: clinical features and prognostic impact; a retrospective study in a surgical centre. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1706] [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
Most cases of infective endocarditis (IE) involve a single valve, and little is known concerning IE that simultaneously affects two valves. The involvement of more than one valve may imply more severe and extensive cardiac lesions. In these patients, surgery may be challenging.
Purpose
We aimed to determine the clinical characteristics, the therapeutic strategy, and the prognostic impact of double-valve IE (DVIE).
Method
We retrospectively included in the analysis 380 consecutive patients with definite active IE in a single surgical centre. The univariate and multivariate long-term survival was analysed by the Kaplan-Meier method and by stepwise Cox proportional hazards models, respectively. We repeated the mortality analysis using the propensity score matching technique, to adjust for baseline differences between SVIE and DVIE groups.
Results
DVIE occurred in 60 of the total enrolled 380 patients (15.8%) and involved mostly the combination of mitral and aortic valves (N=52, 87%). Most patients had double-native IE (N=38, 63%). Staphylococci were significantly less frequent in patients with double-valve than single-valve IE (SVIE). The proportion of patients undergoing valve repair among those treated surgically was higher for patients with DVIE than for SVIE (p<0.001). Valve repair of at least one valve was associated with non-significant better survival than double replacement. DVIE was associated with higher all-cause mortality than SVIE (p<0.001). DVIE was not associated with a higher risk of relapse or non-fatal adverse events.
Conclusions
DVIE represents a considerable proportion of overall cases of IE, mainly involving aortic and mitral valves, with a jet lesion on the mitral valve; Staphylococcus is significantly less frequent than in SVIE; DVIE is independently associated with higher mortality; finally, mitral valve repair is feasible in a considerable proportion of surgical cases.
Funding Acknowledgement
Type of funding sources: None. Propensity score matchingKaplan-Meier analysis: survival of DVIE
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - F Vanni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Ceschia
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Merilli
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - E Sottili
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P L Stefano
- Careggi University Hospital, Cardiac surgery, Florence, Italy
| | - N Marchionni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Marchionni N, Stefàno PL. Heart valve disease in hypocomplementemic urticarial vasculitis syndrome: from immune-mediated degeneration to embolic complications of infective endocarditis-a case report. Eur Heart J Case Rep 2021; 5:ytab341. [PMID: 34622135 PMCID: PMC8491064 DOI: 10.1093/ehjcr/ytab341] [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] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/22/2021] [Accepted: 08/05/2021] [Indexed: 12/14/2022]
Abstract
Background Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare disease due to small vessel inflammation and characterized by chronic urticarial vasculitis and arthritis. Multi-organ manifestations may include glomerulonephritis, ocular inflammation (uveitis, episcleritis), and recurrent abdominal pain. To the best of our knowledge, just other nine cases of HUVS with cardiac valvular involvement have been reported in the literature. Case summary A 32-year-old woman presented to the emergency department because of a cerebral haemorrhage. She suffered from a severe HUVS form with cardiac valvular involvement. In the previous years, she underwent cardiac surgery twice for aortic and mitral valves immune-mediated degeneration. The neurologic event was secondary to Listeria monocytogenes aortic endocarditis, complicated by a cerebral embolism and periaortic abscess. Discussion Patients with HUVS rarely present valvular heart disease. The latter is mostly secondary to an inflammatory process. Valve degeneration and immunosuppressive therapy increase the risk of infective endocarditis, with dramatic consequences for the prognosis of these patients. Valvular involvement is a sporadic but potentially fatal complication of HUVS, which should be taken in mind in the multidisciplinary evaluation of these patients.
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Affiliation(s)
- Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracovascular Department, Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Pier Luigi Stefàno
- Division of Cardiac Surgery, Cardiothoracovascular Department, Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Ceschia N, Scheggi V, Gori AM, Rogolino AA, Cesari F, Giusti B, Cipollini F, Marchionni N, Alterini B, Marcucci R. Diffuse prothrombotic syndrome after ChAdOx1 nCoV-19 vaccine administration: a case report. J Med Case Rep 2021; 15:496. [PMID: 34615534 PMCID: PMC8493358 DOI: 10.1186/s13256-021-03083-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia is emerging as one of the most relevant side effects of adenoviral-based vaccines against coronavirus disease 2019. Given the novelty of this disease, the medical community is seeking new evidence and clinical experiences on the management of these patients. CASE PRESENTATION In this article, we describe the case of a 73-year-old Caucasian woman who presented with diffuse prothrombotic syndrome, both in the arterial and venous districts, following the first dose administration of ChAdOx1 CoV-19 vaccine. The main thrombotic sites included the brain, with both a cortical ischemic lesion and thromboses of the left transverse and sigmoid sinuses and the lower limbs, with deep venous thrombosis accompanied by subsegmental pulmonary thromboembolism. The deep venous thrombosis progressively evolved into acute limb ischemia, requiring surgical intervention with thromboendoarterectomy. Anticoagulation was maintained throughout the whole hospitalization period and continued in the outpatient setting using vitamin K antagonists for a recommended period of 6 months. CONCLUSIONS This case describes the management of vaccine-induced immune thrombotic thrombocytopenia in a complicated clinical scenario, including multisite arterial and venous thromboses. Given the complexity of the patient presentation, this case may implement the comprehension of the mechanisms and clinical features of this disease; it also provides a picture of the challenges related to the management, often requiring a multidisciplinary approach.
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Affiliation(s)
- Nicole Ceschia
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Valentina Scheggi
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Angela Antonietta Rogolino
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Francesca Cesari
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Franco Cipollini
- Department of Internal Medicine, Ospedale San Jacopo, Via Ciliegiole 97, 51100, Pistoia, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Brunetto Alterini
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
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Scheggi V, Del Pace S, Ceschia N, Vanni F, Merilli I, Sottili E, Salcuni L, Zoppetti N, Alterini B, Cerillo A, Marchionni N, Stefàno PL. Infective endocarditis in intravenous drug abusers: clinical challenges emerging from a single-centre experience. BMC Infect Dis 2021; 21:1010. [PMID: 34579674 PMCID: PMC8474874 DOI: 10.1186/s12879-021-06697-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/24/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Intravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE. Methods We retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020. Results Patients reporting IDA (N = 54; 12.2%) were significantly younger (p < 0.001) and presented fewer comorbidities (p < 0.001). IDA was associated with a higher proportion of relapses (27.8 vs. 3.3%, p < 0.001) and, at multivariable analysis, was an independent predictor of long-term mortality (HR 2.3, 95%CI 1.1–4.7, p = 0.015). We did not register multiple relapses in non-IDA patients. Among IDA patients, we observed 1 relapse after discharge in 9 patients, 2 relapses in 5 patients and 3 relapses in 1 patient. In IDA patients, neither clinical and laboratory variables nor the occurrence of even multiple relapses emerged as indicators of an adverse risk–benefit ratio of surgery in patients with surgical indication. Conclusions IE secondary to IDA affects younger patients than those with IE not associated with IDA. Probably due to this difference, IE secondary to IDA is not associated with significantly higher mortality, whereas the negative, long-term prognostic impact of IDA emerges in multivariate analysis. Considering the good prognosis of patients with uncomplicated IE treated medically, surgery should be reserved to patients with a strict- guidelines-based indication. However, since there are no clear predictors of an unfavourable risk–benefit ratio of surgery in patients with surgical indication, all patients with a complicated IE should be operated, irrespective of a history of IDA.
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Affiliation(s)
- Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Stefano Del Pace
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Nicole Ceschia
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Vanni
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Irene Merilli
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Edoardo Sottili
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Leonardo Salcuni
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Nicola Zoppetti
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council, Sesto Fiorentino, Italy
| | - Bruno Alterini
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Alfredo Cerillo
- Division of Cardiac Surgery, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pier Luigi Stefàno
- Division of Cardiac Surgery, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Mazzoni C, Scheggi V, Marchionni N, Stefano P. ST-segment elevation myocardial infarction due to septic coronary embolism: a case report. Eur Heart J Case Rep 2021; 5:ytab302. [PMID: 34557633 PMCID: PMC8453402 DOI: 10.1093/ehjcr/ytab302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/07/2021] [Accepted: 07/13/2021] [Indexed: 12/05/2022]
Abstract
Background Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of the emboli causing acute myocardial infarction is exceedingly rare occurring in <1% of cases. Case summary A 52-year-old man with a history of Bentall procedure and redo aortic valve replacement due to prosthetic degeneration (11 years prior to the current presentation) presented to the emergency department with high-grade fever and myalgias. Shortly after his arrival, he experienced typical chest pain and an electrocardiogram demonstrated signs of inferior ST-elevation myocardial infarction: coronary angiography showed a lesion of presumed embolic origin at the level of the mid-distal circumflex coronary artery which was treated with embolectomy. Transthoracic and transoesophageal echocardiography highlighted the presence of a periaortic abscess. The final diagnosis of infective endocarditis as the cause of septic coronary artery embolization was confirmed with a Positron Emission Tomography-Computed Tomography (PET-CT) exam and by the growth of Staphylococcus lugdunensis on repeated blood cultures. The patient underwent successful redo Bentall surgery the good outcome was confirmed at 1-month follow-up. Discussion Type 2 myocardial infarction caused by coronary embolism is a rare presentation of infective endocarditis and requires a high level of suspicion for its diagnosis. Prosthetic heart valves are a predisposing factor for infective endocarditis: aortic root abscess requires surgery as it rarely regresses with antibiotic therapy.
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Affiliation(s)
- Carlotta Mazzoni
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Pierluigi Stefano
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Ceschia N, Scheggi V, Marchionni N, Stefano P. Case report of a peculiar aneurysm of the ascending aorta: when there is much more beyond an incidental finding. Eur Heart J Case Rep 2021; 5:ytab205. [PMID: 34476336 PMCID: PMC8407484 DOI: 10.1093/ehjcr/ytab205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/27/2020] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
Background Aneurysms of the thoracic aorta are common in male patients around the VI–VII decade of life and most have a degenerative aetiology; otherwise, the occurrence of this disease at a younger age should prompt the search of rarer causes. We report a singular case of ascending aortic aneurysm (AAA) in a young man. Case summary A large AAA accompanied by multivessel dilatation and renal failure of unknown onset was incidentally found in a 23-year-old male during the diagnostic work-up after a car accident. A systemic disease was therefore suspected, and a full clinical investigation revealed the uncommon diagnosis of sarcoidosis accompanied by large vessel vasculitis. Discussion Only a few reports in the literature describe the concurrence of sarcoidosis and large vessel vasculitis (Takayasu arteritis), which may share non-specific immunoinflammatory abnormalities. This case underlines the importance of a multisystem diagnostic approach even in front of an incidental finding that is inconsistent with patient’s age.
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Affiliation(s)
- Nicole Ceschia
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Valentina Scheggi
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Pierluigi Stefano
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134 Florence, Italy
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
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Vanni F, Scheggi V, Marchionni N, Stefàno PL. A new-onset pulmonary artery stenosis in a young man: case report. Eur Heart J Case Rep 2021; 5:ytab118. [PMID: 33937621 PMCID: PMC8068665 DOI: 10.1093/ehjcr/ytab118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/30/2020] [Accepted: 03/04/2021] [Indexed: 11/14/2022]
Abstract
Background Poorly differentiated and undifferentiated sarcomas are the most common primary tumours of the pulmonary arteries. They usually affect large-calibre vessels and present with predominantly intraluminal growth. Dyspnoea, cough, chest pain, and haemoptysis are the most common presenting symptoms. Clinical and imaging manifestations can mimic pulmonary embolisms and correct diagnosis may require multimodal imaging. The overall prognosis is poor; however, early diagnosis and complete surgical resection seem to improve the prognosis. Case summary A 31-year-old male was admitted to our department after a pre-syncopal episode associated with dyspnoea of recent onset. Echocardiography showed a mass with irregular borders attached to the pulmonary artery trunk, almost obliterating its lumen and determining a flow acceleration with a peak velocity and gradient, respectively, of 3.8 m/s and 60 mmHg. At cardiac magnetic resonance imaging and positron emission tomography-computed tomography scan, the mass had inhomogeneous contrast impregnation and an intense 18-fluorodeoxyglucose uptake, both findings are highly suggestive of an angiosarcoma of the pulmonary artery. Biopsy specimens were taken through bronchoscopy but the material was insufficient for diagnosis. The patient decided to continue treatment in another hospital, where he died a few months later. Discussion The presence of a unique mass involving the main trunk of the pulmonary artery or proximal branches associated with rapidly progressive dyspnoea in a patient at low risk for pulmonary embolism should raise the suspicion of primary sarcoma of the pulmonary artery. There are no guidelines for the treatment. Surgery and neo/adjuvant chemotherapy are reported in literature but burdened by bias and concerning a small number of cases.
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Affiliation(s)
- Francesco Vanni
- Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Niccolò Marchionni
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Pier Luigi Stefàno
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Del Pace S, Scheggi V, Virgili G, Caciolli S, Olivotto I, Zoppetti N, Merilli I, Ceschia N, Andrei V, Alterini B, Stefàno PL, Marchionni N. Endocarditis with spondylodiscitis: clinical characteristics and prognosis. BMC Cardiovasc Disord 2021; 21:186. [PMID: 33858337 PMCID: PMC8051097 DOI: 10.1186/s12872-021-01991-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The association of infective endocarditis (IE) with spondylodiscitis (SD) was first reported in 1965, but few data are available about this issue. This study aimed to evaluate the prevalence of SD in patients with IE, and to determine the clinical features and the prognostic impact of this association.
Methods We retrospectively analysed 363 consecutive patients admitted to our Department with non-device-related IE. Radiologically confirmed SD was revealed in 29 patients (8%). Long-term follow-up (average: 3 years) was obtained by structured telephone interviews; in 95 cases (13 of whom had been affected by SD), follow-up echocardiographic evaluation was also available.
Results At univariable analysis, the combination of IE with SD was associated with male gender (p = 0.017), diabetes (p = 0.028), drug abuse (p = 0.009), Streptococcus Viridans (p = 0.009) and Enterococcus (p = 0.015) infections. At multivariable analysis, all these factors independently correlated with presence of SD in patients with IE. Mortality was similar in patients with and without SD. IE relapses at 3 years were associated with the presence of SD (p = 0.003), Staphylococcus aureus infection (p < 0.001), and drug abuse (p < 0.001) but, at multivariable analysis, only drug abuse was an independent predictor of IE relapses (p < 0.001; HR 6.8, 95% CI 1.6–29). At echocardiographic follow-up, SD was not associated with worsening left ventricular systolic function or valvular dysfunction. Conclusions The association of IE with SD is not rare. Hence, patients with IE should be screened for metastatic infection of the vertebral column, especially if they have risk factors for it. However, SD does not appear to worsen the prognosis of patients with IE, either in-hospital or long-term.
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Affiliation(s)
- Stefano Del Pace
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Valentina Scheggi
- Cardiovascular and Perioperative Medicine, University of Florence, Florence, Italy. .,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Giacomo Virgili
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Sabina Caciolli
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Iacopo Olivotto
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Nicola Zoppetti
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council, Sesto Fiorentino, Italy
| | - Irene Merilli
- Cardiovascular and Perioperative Medicine, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Nicole Ceschia
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Valentina Andrei
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Bruno Alterini
- Cardiovascular and Perioperative Medicine, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pier Luigi Stefàno
- Cardiac Surgery, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Scheggi V, Merilli I, Marcucci R, Del Pace S, Olivotto I, Zoppetti N, Ceschia N, Andrei V, Alterini B, Stefàno PL, Marchionni N. Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre. BMC Cardiovasc Disord 2021; 21:28. [PMID: 33435885 PMCID: PMC7802147 DOI: 10.1186/s12872-021-01853-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/23/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose Mortality in infective endocarditis (IE) is still high, and the long term prognosis remains uncertain. This study aimed to identify predictors of long-term mortality for any cause, adverse event rate, relapse rate, valvular and ventricular dysfunction at follow-up, in a real-world surgical centre.
Methods We retrospectively analyzed 363 consecutive episodes of IE (123 women, 34%) admitted to our department with a definite diagnosis of non-device-related IE. Median follow-up duration was 2.9 years. Primary endpoints were predictors of mortality, recurrent endocarditis, and major non-fatal adverse events (hospitalization for any cardiovascular cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), and ventricular and valvular dysfunction at follow-up.
Results Multivariate analysis independent predictors of mortality showed age (HR per unit 1.031, p < 0.003), drug abuse (HR 3.5, p < 0.002), EUROSCORE II (HR per unit 1.017, p < 0.0006) and double valve infection (HR 2.3, p < 0.001) to be independent predictors of mortality, while streptococcal infection remained associated with a better prognosis (HR 0.5, p < 0.04). Major non-fatal adverse events were associated with age (HR 1.4, p < 0.022). New episodes of infection were correlated with S aureus infection (HR 4.8, p < 0.001), right-sided endocarditis (HR 7.4, p < 0.001), spondylodiscitis (HR 6.8, p < 0.004) and intravenous drug abuse (HR 10.3, p < 0.001). After multivariate analysis, only drug abuse was an independent predictor of new episodes of endocarditis (HR 8.5, p < 0.001). Echocardiographic follow-up, available in 95 cases, showed a worsening of left ventricular systolic function (p < 0.007); severe valvular dysfunction at follow-up was reported only in 4 patients, all of them had mitral IE (p < 0.03). Conclusions The present study highlights some clinical, readily available factors that can be useful to stratify the prognosis of patients with IE.
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Affiliation(s)
- Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50143, Florence, Italy.
| | - Irene Merilli
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50143, Florence, Italy
| | - Rossella Marcucci
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Stefano Del Pace
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Iacopo Olivotto
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Nicola Zoppetti
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council, Sesto Fiorentino, Italy
| | - Nicole Ceschia
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Valentina Andrei
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Bruno Alterini
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50143, Florence, Italy
| | - Pier Luigi Stefàno
- Division of Cardiac Surgery, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
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Scheggi V, Olivotto I, Del Pace S, Zoppetti N, Brunetto A, Marchionni N, Cerillo A, Stefàno PL. Feasibility and outcome of mitral valve repair in patients with infective endocarditis. Cardiothorac Surg 2020. [DOI: 10.1186/s43057-020-00037-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Valve repair is the treatment of choice for native mitral valve regurgitation. The feasibility of repair when the defect is caused by acute infective endocarditis (IE) is debated. This study aims to compare the outcome of repair and replacement procedures, to report the rate of repair in a single surgical center, and to review the literature on this topic.
Results
We retrospectively analyzed 108 patients with native mitral IE, potentially eligible for surgical repair. Of these 108, 90 (83%) underwent surgery, and 18 were treated conservatively. Among the 90 surgical patients, 57 (63%) underwent valve replacement and 33 valve repair (37%). The mean follow-up duration was 3 years. The two primary endpoints were mortality and freedom from recurrent endocarditis. Secondary endpoints were the post-operative incidence of major adverse events (hospitalization for any cause, pacemaker implantation, new onset of atrial fibrillation, sternal dehiscence), left ventricular systolic function (LVSF), and valvular function at 1-year echocardiographic follow-up. All-cause mortality was lower for valve repair, although not significantly (p = 0.86), as well as nonfatal adverse events (p = 0.92) and relapse rate (p = 0.20) at 3 years. We did not find differences between the two groups at echocardiographic follow-up, neither for left ventricular systolic function (p = 0.22), nor for valvular continence (p = 0.28).
Conclusions
In our experience, the mid-term outcome of repair in IE is comparable to valve replacement and should be considered whenever possible, as in degenerative valve disease. The review of the literature supports this strategy.
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Andrei V, Scheggi V, Stefàno PL, Marchionni N. Primary cardiac sarcoma: a case report of a therapeutic challenge. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33629020 PMCID: PMC7891279 DOI: 10.1093/ehjcr/ytaa404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/02/2020] [Revised: 06/23/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are very rare and the prognosis is poor both because the diagnosis is typically made at an advanced stage of the disease and because data are insufficient to identify a standard treatment. Surgical resection is the cornerstone of therapy with the need to develop new therapeutic strategies. CASE SUMMARY We present a case of a young man admitted to the emergency department due to worsening dyspnoea. A left-sided sarcoma was diagnosed and treated with surgery, chemo- and radiation therapy, and subsequently with heart transplant for local recurrence of the disease. Endomyocardial biopsy made during the routine follow-up period was complicated by pericardial tamponade and cardiogenic shock and the patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of left ventricular function (left ventricular ejection fraction of 55%). After 1 year a kidney transplant was performed. After 42 months from diagnosis, the patient is in good general condition. DISCUSSION Primary cardiac sarcomas are treated with surgery to reach R0 (free resection margins) and with chemo- and radiation therapy with adjuvant purposes. Auto-transplantation is also performed, while conventional heart transplant must be customized on an individual basis, after excluding metastases. A multidisciplinary assessment should be performed and the single patient treated with a personalized approach, in relation to his performance status, location of the mass, and stage of the disease.
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Affiliation(s)
- Valentina Andrei
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Pier Luigi Stefàno
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
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Scheggi V, Mariani T, Mazzoni C, Stefàno PL. A case of needle embolism in a drug abuser, a diagnostic and therapeutic challenge. Cardiothorac Surg 2020. [DOI: 10.1186/s43057-020-00036-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Needle embolism is a rare complication of intravenous habit. Clinical manifestations include recurrent pericarditis, tamponade, cardiac perforation, and infective endocarditis. We describe the case of needle embolization in a young intravenous opiate abuser.
Case presentation
We describe a rare complication of intravenous misuse in a 23-year-old patient. He presented at the emergency department with chest pain and shortness of breath. He complained of remittent fever ensued 6 months before. Echocardiographic and radiologic images revealed pericardial effusion and a needle fragment inside the pericardium. The needle was removed through left-anterior mini-thoracotomy, after CT-guided carbon tracking.
Conclusions
The presence of a foreign body within the heart resulted from the migration of a needle fragment from a peripheral vessel. It caused fever and recurrent pericarditis. In similar cases, surgical extraction is the therapy of choice.
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Scheggi V, Olivotto I, Ceschia N, Merilli I, Andrei V, Alterini B, Stefano P. Predictors of adverse prognosis in patients with infective endocarditis in a surgical referral center. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1880] [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
Despite optimal medical and surgical treatment, mortality in infective endocarditis (IE) remains high. Aim of this study was to identify predictors of long term mortality for any cause, adverse event rate, relapse rate and valvular dysfunction at follow-up, in a high-volume surgical center.
Methods
We retrospectively analyzed 358 consecutive patients (127 women) admitted to our department with definite diagnosis of IE not device-related. IE occurred on native valves in 224 patients (63%); the infection involved the aortic valve in 192 (54%), mitral valve in 139 (39%) and tricuspid valve in 26 (7%). Overall 285 (80%) patients underwent surgery and 73 (20%) were treated conservatively, 38 due to absence of surgical indication and 35 due to refusal or prohibitive surgical risk. Long-term follow-up was obtained by structured telephone interviews. Primary endpoints were all-cause mortality, freedom from recurrent endocarditis, postoperative incidence of major adverse events (hospitalization for any cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), worsening of left ventricular ejection fraction (LVEF) and valvular dysfunction.
Results
Mean age was 65 years (SD 15.2). Mean vegetation length was 8.9 mm (SD 7.6). Endocarditis was left-sided in 332 (93%). Average follow-up was 6 months. At univariable analysis, mortality was associated with female gender (p=0.031), age (p<0.001), higher EuroSCORE 2 (p<0.001), chronic renal failure (p<0.001), diabetes (p=0.002), brain embolism on presentation (p=0.05), double valve infection (p=0.008), low ejection fraction (p<0.001), paravalvular extension (p=0.031), prosthetic infection (p=0.018), exclusion from surgery if indicated (p<0.001), high procalcitonin levels (p=0.035); factors associated with a significantly lower mortality were streptococcal infection (p=0.04; OR 0.34) and early surgery (p=0.009, OR 0.55). At multivariable analysis independent predictors of all-cause mortality were lower EF, EuroSCORE2, procalcitonin levels and diabetes. Non-fatal adverse events were associated with renal failure (p 0.035, OR 2.8). Relapse rate was associated with S aureus infection (p=0.005, OR 3.8), right-sided endocarditis (p<0.001, OR 6.7) and drug abuse (p<0.001, OR 9.4).
Conclusions
The present study shows that low EF, EuroSCORE2, procalcitonin levels and diabetes are independent predictors of death in patients with IE. Non-fatal adverse events are more frequent in patients with renal failure. Relapse rate is higher in drug abusers. These informations may help personalize follow-up strategies after acute admission for IE.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Olivotto
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Ceschia
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Merilli
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - V Andrei
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P.L Stefano
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Olivotto I, Alterini B, Merilli I, Starnazzi F, Ceschia N, Andrei V, Stefano P. Valve repair in patients with infective endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2685] [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
Valve repair is considered the treatment of choice for native mitral and tricuspid valve regurgitation but the rate of feasibility when the defect is caused by acute infective endocarditis (IE) is debated. We report the experience of valve repair versus replacement following IE in a high-volume surgical center.
Methods
We retrospectively analyzed 351 consecutive patients (123 women) admitted to our department with definite diagnosis of IE. IE occurred on native valves in 219 patients (62%) and on prosthetic valves in 132 (38%). Among native valves, IE involved the aortic valve in 105 cases (48%), mitral valve in 97 cases (44%) and tricuspid valve in 17 (8%). Since only native mitral and tricuspid valves are elegible for surgical repair, we limited the analysis to this subset (114 patients); of them, 92 (80.7%) underwent surgery (the final cohort) and 22 were treated conservatively, 13 due to absence of surgical indication and 9 due to prohibitive surgical risk. Long-term follow-up was obtained by structured telephone interviews. Primary endpoints were mortality and freedom from recurrent endocarditis. Secondary endpoints were the postoperative incidence of major adverse events (hospitalization for any cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence).
Results
Mean age at surgery was 61.9 years (SD 14.5). Mean vegetation length was 11.6 mm (SD 8.8). Endocarditis was left-sided in 80 (87%). Among the 92 surgical patients, 58 (63%) underwent valve replacement and 34 valve repair (37%). Mortality was similar between valve repair and replacement (15 vs 12%). Adverse events rate (19% vs 16%) and relapse were not statistically different between repair and replacement procedures.
Conclusions
The present study shows that a sizeable subgroup of consecutive patients with native mitral or tricuspid IE are amenable to valve repair in expert hands. Outcome of repair in IE is comparable to valve replacement mid-term, and should be considered whenever possible, as in degenerative valve disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Olivotto
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Merilli
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - F Starnazzi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Ceschia
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - V Andrei
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P.L Stefano
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Del Pace S, Virgili G, Stefano P. Spondylodiscitis and endocarditis, the strange couple. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1895] [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
The association between spondylodiscitis and infective endocarditis (IE) was first reported in 1965 but only a few data are available in the literature about this clinical picture. Early diagnosis of infective endocarditis as the source of spondylodiscitis is often difficult. The aim of this study was to evaluate the proportion of spondylodiscitis in patients with IE and to determine its clinical features.
Methods
We retrospectively analyzed 355 consecutive patients (127 women) admitted to our department with definite diagnosis of IE. Mean age was 65 years (SD 15.3). IE occurred on native valves in 223 patients (63%) and it involved the aortic valve in 191 cases (54%), mitral valve in 138 cases (39%) and tricuspid valve in 26 (7%). Spondylodiscitis occurred in 24 patients (7%). The diagnosis of spondylodiscitis was made on the basis of typical clinical and radiologic signs. Long-term follow-up was obtained by structured telephone interviews. Average duration of follow-up was three years. Primary endpoint was to establish clinical features of patients with IE complicated by spondylodiscitis.
Results
At univariable analysis spondylodiscitis was associated with male sex (p=0.043), diabetes (p=0.049), drug abuse (p=0.017) and enterococcus infection (p=0.043). At multivariable analysis diabetes (p=0.014) and drug abuse (p=0.006) were independently correlated with the presence of spondylodiscitis. Other clinical features were not associated with the presence of spondylodiscitis (age, BMI, chronic renal failure, paravalvular extension of infection, vegetation length, EuroScore 2, PCR and procalcitonin levels, type of valve infected). Mortality was similar between patients with and without spondylodiscitis.
Conclusions
The association of spondylodiscitis and infectious endocarditis should always be suspected, expecially in patients with a high risk profile. Hence, patients with spondylodiscitis should be submitted to echocardiography, mainly when the infective organism is an Enterococcus. Conversely, patients with IE should undergo screening for methasthatic infection.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - S Del Pace
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - G Virgili
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P.L Stefano
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Alterini B, Olivotto I, Del Pace S, Zoppetti N, Tomberli B, Bartalesi F, Brandi L, Ceschia N, Andrei V, Suardi LR, Marchionni N, Stefàno PL. Embolic risk stratification and prognostic impact of early surgery in left-sided infective endocarditis. Eur J Intern Med 2020; 78:82-87. [PMID: 32317239 DOI: 10.1016/j.ejim.2020.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/19/2020] [Revised: 03/13/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In patients with left-sided infective endocarditis (IE) and heart failure associated with large vegetations, early surgery prevents embolic events. However, optimal timing of surgery for other indications is still unresolved particularly when the presence of large vegetations represents the sole indication. METHODS We retrospectively analyzed 308 consecutive patients admitted to our department with definite left-sided IE. Of these patients, 243 (79%) underwent cardiac surgery (complicated IE), 34 patients with uncomplicated IE received medical treatment, 24 were not operated due to prohibitive general conditions and 7 refused surgery. Long-term follow-up was obtained by structured telephone interviews. RESULTS During the 6-year follow-up (average 121.8 weeks ± 76), patients not operated because of general conditions or refusal had the worst prognosis, while outcome in operated patients for complicated IE was comparable to that of uncomplicated IE treated medically. Early (<2 weeks from diagnosis) surgery was associated with better survival compared to delayed surgery (HR 0.58, p = 0.23). Embolic events were detected at admission in 38% of cases; Staphylococcus Aureus etiology and vegetation size were independently associated with embolism (OR 2.4, p = 0.01; OR 1, p=0.008 respectively). CONCLUSIONS Compared to uncomplicated medically-treated patients, complicated IE showed comparable survival when managed aggressively by surgical intervention, whereas a conservative approach was associated with an adverse prognosis. Staphylococcus Aureus infection and vegetation size were independent predictors of systemic embolism. Our data support aggressive surgical management of complicated IE patients and highlight the importance of etiological characterization in clinical decision-making.
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Para O, Zaccagnini G, Corbo L, Pieralli F, Mancini A, Scheggi V, Tramonte F, Nozzoli C. Pneumocystis pneumonia in HIV-negative immunocompromised patients in Internal Medicine ward. Ital J Med 2020. [DOI: 10.4081/itjm.2020.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection typically observed in AIDS patients, for whom it represents a leading cause of death. However, its incidence among HIV-negative immunocompromised patients is progressively increasing, with a significantly higher mortality compared to that of AIDS-patients. We performed a retrospective observational study on HIV-negative patients with PJP. We aimed to determine their epidemiological features and their biohumoral and therapeutic variables, searching for a correlation between them and our patients’ outcome. We included all patients admitted to our Internal Medicine ward from January 2010 to June 2015, who were immunocompromised at the time of admission and had microbiologically confirmed PJP (association between compatible clinical-radiological findings and qualitative polymerase chain reaction positivity on bronchoalveolar lavage). Their immune impairment was assessed considering both their medical history and their complete white blood cells (WBC), differential WBC and their CD4 cell count. Transfer to Intensive Care Unit (ICU) or death was considered as an unfavorable clinical outcome, while hospital discharge or transfer to a non-ICU ward was considered as a favorable outcome. We included a total of 18 patients in our statistical analysis. We used Student’s t-test and Fischer’s χ-square test to compare, respectively, normally distributed continuous variables and non-continuous variables. Our patients’ mean age was 65±13.9 years. All of them had cancer, mostly hematological malignancies (13/18), notably non-Hodgkin lymphoma (NHL; 8/13). They were all being or had been recently treated with chemotherapy (10/18) and/or high-dose glucocorticoids, with full dose or during tapering (13/18). Statistical analysis of blood tests results showed a significant difference between mean serum lactate dehydrogenase (LDH) concentration in the group of patients with favorable vs unfavorable outcome. Also, mean serum immunoglobulins G (IgG) concentration and certain arterial blood gas findings (mean arterial paO2/FiO2, mean blood Ph and mean paCO2) at the time of admission were significantly different in the two groups of patients. 12/18 patient’s outcome turned out unfavorable. Trimethoprim + sulfamethoxazole (TMP+SMX) treatment was given to all our patients, with a mean duration of 13.39±9.36 days. Patients with a favorable outcome had received TMP+SMX treatment significantly earlier than those with an unfavorable outcome. Hematological malignancies, according to literature, confer the strongest predisposition to PJP. Both chemotherapy and high-dose Glucocorticoid treatment are well known predisposing factors. A remarkable elevation of serum LDH represents both a typical clinical feature and a well-known negative prognostic factor in PJP. Low IgG levels have never been reported as a negative prognostic factor, but their role in enhancing macrophage killing of pneumocystis may account for the worst observed prognosis in the group of patients with lower mean levels. Therefore, in order to reduce the heavy mortality rate associated with PJP, an early beginning of specific treatment is of utmost importance, and even if this is certainly true for many infectious diseases, the time gap is particularly limited in the setting of this type of pneumonia. Hence, PJP should be ruled out as soon as possible and, in case of a strong clinical- radiological suspicion, therapy should be started immediately, even while waiting for microbiological confirmation (especially in critically-ill patients).
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Scheggi V, Mazzoni C. P848 Left sided cardiac lymphoma. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.496] [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
Primary cardiac lymphoma (PLC) is a rare neoplasm, defined as a lymphoma with the main bulk localized in the heart; diffuse B-cell lymphoma (DLBCL) is the most common type. It usually involves the pericardium and the right heart, especially the right atrium, and have a poor prognosis with a median survival of less than one year.
Case summary
A 62-year-old female presented to the emergency department on February 2018 for palpitations and recent-onset dyspnea on exertion. Her previous medical history was unremarkable except for a hospital admission in october 2017 for dyspnea, when she underwent pleuroscopy of a left pleural effusion with histologic findings negative for a neoplastic process.
The echocardiogram showed a round-shaped mass (23x13mm) in the left atrium, attached to its lateral wall, a mild circumferential pericardial effusion and an hyperechogenic mass at the level of the atrio-ventricular junction of suspected pericardial origin.
A subsequent thoracic CT scan demonstrated the presence of a bulky mediastinal mass with colliquative aspects developing around the cardiac structures, strictly attached to the left heart and infiltrating its posterior wall, the left pulmonary veins and the inferior lobar bronchus. Another mass of similar characteristics surrounded the antero-superior portion of the right heart. Colliquative lymphadenopathies and a left basal pleural effusion were also present.
After performing a total-body CT scan which excluded the presence of lesions in other districts, the patient underwent CT-guided biopsy and the diagnosis of double-expressor DLBCL was made. Given the potential risk of heart rupture during chemotherapy, the first cycle of R-CHOP was performed in a in-hospital setting with initial reduction of the mediastinal mass and of the lymphadenopathies. The patient was discharged home and referred to the hematology department. After completing 6 cycles of R-CHOP, imaging studies showed rapid progression of the disease; the patient was then started on the salvation protocol R-DHAOX but died of septic shock in december 2018.
Discussion
PCL is rare and accounts for less than 2% of primary cardiac tumors; double-expressor DLBCL carries a poor prognosis.
As in most cases, diagnosis was made after the onset of nonspecific symptoms (dyspnea) but -despite the strong predilection for right heart involvement reported in literature- our patient had a predominant left atrial infiltration.
Abstract P848 Figure.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - C Mazzoni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Mariani T, Alterini B. P842 The sword in the heart. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.491] [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
Needle embolism is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Potential sequelae include cardiac perforation, tamponade, infective endocarditis and recurrent pericarditis. We report the case of a young intravenous opiate abuser.
Case Report
A 23-year-old heroin addicted man presented to the emergency department because of chest pain ensued six months before; the pain was sharp, was relieved by sitting up and leaning forward and increased with coughing, swallowing, deep breathing or lying flat. He complained also fatigue and fever since one month before presentation.
Echocardiography revealed non haemodinamic pericardial effusion and pleural effusion, treated with pleural drainage. Three haemocoltures were negative. Cardiac biomarkers were negative. HIV, HBV and HCV sierology was negative. He was treated with cochicine and ibuprofen and empiric antibiotic therapy with initial improvement of symptoms and rapid recurrence of them. After a few weeks an ECG showed widespread concave ST segment elevation and an echocardiogram revealed pericardial effusion relapse.
A chest radiograph showed a needle near the right ventricle. The patient underwent computed tomography angiography that was able to localize a needle inside the pericardium. A second echocardiogram confirmed the presence of the fragment in the pericardial cavity, beside the right ventricle.
The patient underwent minithoracototomy surgical removal of the needle fragment and of 500 cc of haematic pericardial fluid.
Discussion and conclusions
The presence of a foreign body in the heart may result from either a direct injury to the heart such as a gunshot injury or from some other embolization to the heart from distal penetration sites (eg, the migration of a catheter or a needle fragment from a peripheral vessel). It may cause fever, recurrent pericarditis and arrhythmia. Surgical extraction in the therapy of choice.
Abstract P842 Figure.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - T Mariani
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Olivotto I, Alterini B. P1457 Septic and aseptic valvular involvement in hypocomplementemic urticarial vasculitis syndrome. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.884] [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
Hypocomplementemic Urticarial Vasculitis Syndrome (HUVS) is a very rare disease involving small vessels and characterized by chronic urticarial vasculitis, arthralgia, arthritis, and activation of the classical complement pathway. To our knowledge, just other seven cases of HUVS with cardiac valvular involvement have been reported in the literature. Unlike previous cases, ours shows a broader antibody positivity, (but no anti-C1q antibodies) with an early and serious cardiovascular involvement.
Case summary
A 32 years old woman was brought to the emergency department because of sudden onset of right hemiplegia and global aphasia due to cerebral haemorrage.
She suffered from a severe HUVS form with cardiac valvular involvement and she was cronically treated with immunosuppressant drugs.
During previous years she had already undergone cardiac surgery twice for chronic aseptic inflammatory process involving aortic and mitral valves.
Right hemiplegia and global aphasia were caused by septic embolism to left cerebral artery complicated by cerebral haemorrage.
The patient underwent neurosurgical intervention followed by antibiotic therapy.
This condition was secondary to Listeria monocytogenes aortic infective endocarditis in an immunosuppressed patient.
Transesophageal echocardiogram showed periaortic abscess with internal colliquation.
A further surgical intervention would have been necessary, but operative risk was judged to high and the patient died one year later.
Discussion
The association between HUVS, Jaccaud"s arthropathy and cardiac valvular disease is rarely described in the literature. The presence of valvular involvement is a negative prognostic factor.
Unlike most cases, it is interesting to note that our patient was negative for anti-C1q antibodies and exhibited an extremely severe cardiac involvement.
The case was complicated by L monocytogenes endocarditis, that is also a rare condition associated with a high mortality rate.
Abstract P1457 Figure. Abscess
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - I Olivotto
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Mazzoni C. P233 A new onset pulmonary artery stenosis in a young man. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.098] [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: 11/15/2022] Open
Abstract
Abstract
Background
Poorly differentiated and undifferentiated sarcomas are the most common primary tumors of the pulmonary arteries. They usually affect large caliber vessels and present with predominantly intraluminal growth. Dyspnea, cough, chest pain, and hemoptysis are the most common presenting symptoms; patients may have signs of chronic pulmonary hypertension. Clinical and imaging manifestations can mimic pulmonary embolism.
The overall prognosis is poor
combined therapy with surgical resection and chemo-radiotherapy offers the best survival rates.
Case presentation
A 31-year-old male was referred to our department because of recent onset dyspnea, a pre-syncopal episode and a new heart murmur.
He had normal spirometry results but a significant desaturation during the 6MWT. A thoracic CT scan showed an incremented diameter of the pulmonary artery.The echocardiogram showed the presence of a mass with irregular borders attached to the pulmonary trunk almost obliterating its lumen. The mass determined a flow acceleration with maximal velocity of 3.8 m/sec, and a peak gradient of 60mmHg; Doppler findings on the pulmonary valve and right heart function were within normal values. Compression ultrasonography ruled out the presence of deep vein thrombosis.
The lesion showed a dishomogeneous impregnation in the contrastographic phase at cardiac MRI and had an intense glucidic metabolism at a PET-CT scan. These findings were highly suggestive of an angiosarcoma of the pulmonary artery. Biopsy specimens were taken through bronchoscopy.
The patient then decided to continue treatment in another hospital, where the histologic samples were sent; the cytologic results showed atypical cellular elements. The patient died a few months later.
Discussion
The presence of a unique mass in the main pulmonary artery or proximal branches and rapidly progressive dyspnea in a patient at low risk of pulmonary embolism should raise the suspicion of primary sarcoma of the pulmonary artery, which is a rare but aggressive tumor with a very poor prognosis.
Abstract P233 Figure.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - C Mazzoni
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Stefano PL, Alterini B. P1306 A large cardiac mass of left sections in a young man. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.750] [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
Heart tumors are very rare lesions. Their prevalence is about 0.001 to 0.03 % in an autopsy series.
In most cases, primitive lesions are benign, with atrial myxomas that represent up to 2/3 of cases. Malignant neoplasms have a high mortality; sarcomas are the most frequent typologies. The most aggressive tumors are characterized by greater size, muscle invasion and pericardial effusion.
Clinical case
A 39-year-old man with recent history of worsening dyspnea went to the emergency room because of an aggravation of the symptoms.
An echocardiogram showed a large atrial inhomogeneous mass, adherent to the mitral ring and involving both left atrial and ventricle, causing a severe valvular stenosis, suggestive for malignancy. Thus the patient performed a cardiac-MRI, confirming the neoplasm localization with parietal infiltration, pericardial extension and effusion. A total-body CT scan ruled out metastasis. The patient underwent heart surgery and a partial excision was performed. Macroscopically the tumor had a scirrhous consistency and a diameter of about 5 cm. The histologic examination showed a high-grade sarcoma with fused cells and with condrosarcomatous areas.
Discussion
The study of heart massesincludes the execution of echocardiographies as first-line examinations, while the in-depth diagnostics (necessary in the anticipation of surgery) require cardiac-MRI or CT. Malignant lesions are characterized by an inomogeneous appearance, with a wide plant base and sizes larger than 5 cm, they are also able to take contrast medium during diagnostic examinations. High grade neoplasms are rapidly evolving with a very severe prognosis. The symptoms are essentially due to the localization and the mass bulk. In our case, its development on the mitral valve caused severe hemodynamic impairment, requiring immediate intervention. The treatment of these lesions is necessarily surgical. The only positive prognostic factor is a complete excision of neoplasm with free resection margins. As the diagnosis is often not early, chemotherapy or radiotherapy are often required after surgery.
Conclusion
Cardiac masses are rare entities and their evaluation may be a diagnostic challenge. Myxoma represent the most common primary cardiac neoplasm in adults, while about 25% of other primary ones are malignant. Our patient was suffering from a sarcoma, whose incomplete debulking made further therapies necessary. The correct interpretation of instrumental findings together with a possible radical surgery are mandatory for a successful therapeutic strategy.
Abstract P1306 Figure.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P L Stefano
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - B Alterini
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Scheggi V, Ceschia N, Andrei V, Stefano PL. P2757Embolic risk stratification and prognostic impact of early surgery in left-sided infective endocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1074] [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
Surgery is performed in 50% to 60% of infective endocarditis. In patients with definite surgical indication for hearth failure and with large vegetation, early surgery prevents embolic events. The optimal timing of surgery for other indications is still debated. Moreover, patients with large vegetation as unique indication to surgery, have a weak class of recommendation to it. Accurate risk stratification for embolic events is desirable to optimize selection of surgical candidates.
Materials and methods
We retrospectively analyzed 195 consecutive patients (72 women and 123 men) admitted to our department between 2013 and 2017 with definite IE according to modified Duke University criteria. Transesophageal echocardiography and blood cultures were performed in all patients for confirmation of diagnosis. Systemic embolism was soughton admission clinically and with imaging techniques (Brain and chest CT plus abdominal CT or US scan). Seventy-seven percent of patients underwent surgery (valve repair or replacement). Outcome following discharge was systematically assessed by structured telephone interviews.
Results
Of the 195 patients with left sided IE, 151 underwent surgery, 29 were low risk and treated medically, 5 refused surgery and 10 were not operated due to high surgical risk. Overall survival was 78% at 4 years. Patients excluded from surgery had the worst prognosis, while operated patients with high-risk IE showed comparable survival to non-complicated infections treated medically. Early surgery (<2 weeks from diagnosis) was associated with similar survival compared to later intervention. Euroscore II was the main predictor of mortality when above a threshold of 7 before 2015 and 16 after 2015, reflecting surgical management of higher risk patients over time.In left sided IE, mean vegetation length was 11.1 mm; embolic events before diagnosis occurred in 35% of cases and Staphylococcus aureus etiologywas the main risk factor associated with embolism (OR 4, p<0.05). Vegetation size >10 mm was also independently associated with embolic risk (p=0.033) whereas renal failure, age, sex, endocarditis location (mitral or aortic), type of valve (native or prosthetic), perivalvular extension and degree of valveregurgitation were not.
Conclusions
Compared to low-risk IE patients treated medically, those at high-risk showed comparable survival when managed surgically, whereas a conservative approach was associated with adverse prognosis. In patients with left sided IE and intermediate vegetation length, S. aureus infection was the best independent predictor of systemic embolic events. Our data support extensive surgical referral in high risk IE and suggest that its etiology represents an important factor in decision-making.
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Affiliation(s)
- V Scheggi
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - N Ceschia
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - V Andrei
- Careggi University Hospital, Department of Cardiology, Florence, Italy
| | - P L Stefano
- Careggi University Hospital, Department of Cardiology, Florence, Italy
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Giglioli C, Cecchi E, Angelotti P, Venditti F, Calabretta R, Scheggi V, Alterini B, Stefano P. Aortopulmonary fistula presenting with right ventricular dysfunction following blunt chest trauma. J Card Surg 2013; 28:713. [PMID: 24118078 DOI: 10.1111/jocs.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cristina Giglioli
- Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Del Pace S, Scheggi V. Acute ischaemic stroke treated with combined intra-arterial thrombolysis and intravenous tirofiban despite oral anticoagulant therapy at an international normalised ratio > or = 2.0. Intern Emerg Med 2006; 1:250-2. [PMID: 17120479 DOI: 10.1007/bf02934752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Poggesi L, Scheggi V, Ammannati F, Bono P. A case of brain abscess by Eikenella corrodens in a HIV-positive patient. Ann Ital Med Int 2003; 18:162-6. [PMID: 14621427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
We report the case of a 61-year-old homosexual male who came to our observation because of a recent onset occipital and left frontoparietal headache, weakness, anorexia, hyperosmia and hypergeusia and psychomotor slowing, apathy and fatuous behavior. This case, besides the old problem of the differential diagnosis of intracranial mass lesions in HIV-positive patients, induces one to examine more closely the relationship between HIV, brain abscesses and Eikenella corrodens. We suspect that the primary infection was in the oral cavity, since HIV-positive patients have a higher incidence of atypical gingivitis and typical periodontitis due, among others, to Eikenella corrodens.
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