Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987-2013).

AIMS: Use of cardiac pacing devices has grown in recent years. Our aim was to evaluate changes in epidemiology and clinical features of infective endocarditis (IE) involving pacemaker devices in a large series of IE over the last 27 years (1987-2013). METHODS AND RESULTS: From 1987 to December 2013, 413 consecutive IE cases were diagnosed in our hospital. During this period, 7424 pacemaker devices were implanted (6917 pacemakers, 239 implantable cardiac defibrillators, 158 resynchronization devices, and 110 resynchronization/defibrillator devices). All consecutive cases of IE on pacemaker devices were included and analysed. Infective endocarditis on pacemaker devices represented 6.1% of all endocarditis cases (25 patients), affecting 3.6/1000 of all implanted pacemakers. Its proportion increased from 1.25% of all endocarditis in 1987-1993 to 4.08% in 1994-2000, 7.69% in 2001-2007 and 9.32% in 2008-2013 (P < 0.01). Its incidence also increased from 1.4/1000 of all pacemaker implants in the period of 1987-1993 to 2.5/1000 in 1994-2000, 3.3/1000 in 2001-2007 and 4.5/1000 implanted devices in 2008-2013 (P < 0.05). Mean age of patients was 68 years, and 80% were male. Causative microorganisms predominantly were Staphylococci (84%: Staphylococcus aureus 48%, Staphylococcus epidermidis 36%). Rate of severe complications was high: persistent sepsis in 60% of cases, heart failure in 20%, and stroke in 12%. Device was removed in 19 patients (76%), mostly by surgery (18 of the 19 cases). Early mortality was 24% (33% of medically, 21% of surgically treated patients, P = 0.82). CONCLUSION: Infective endocarditis on pacemaker devices has shown an increasing incidence during the past decades, representing almost 10% of all IE in the last 6 years. This is a severe disease, with a high rate of severe complications and requiring removal of device in most cases. In spite of therapy, early mortality is high.

Impact of asymptomatic acute cellular rejection on left ventricle myocardial function evaluated by means of two-dimensional speckle tracking echocardiography in heart transplant recipients.

BACKGROUND: Our objective was to evaluate the impact of asymptomatic acute cellular rejection (ACR) in left ventricular myocardial strain in heart transplant (HT) recipients by means of two-dimensional speckle tracking echocardiography (2DSTE). METHODS: From September 1, 2009 to December 15, 2010 a conventional echocardiography and 2DSTE exam was performed on all consecutive HT recipients in their first year posttransplantation within 3 hours of the surveillance endomyocardial biopsies, as well as on 14 healthy controls. The association of strain echocardiographic variables with different grades of ACR was investigated. RESULTS: Of the 78 studies performed 4 ± 3 months after HT in 20 patients, 32 studies were coincident with grade 0R rejection, 41 with grade 1R, and 5 with grade 2R. Significantly lower values of average radial strain were found with higher grades of ACR (29.1 ± 7.7%, 23.2 ± 8.5%, and 14.3 ± 8.8% for grades 0R, 1R, and 2R of ACR, P = 0.001). Average deformation was similar for controls versus transplanted patients, in the absence of acute rejection: radial 29.1 ± 10.0% versus 29.1 ± 7.7%, P = 0.98; circumferential -19.3 ± 3.2% versus -20.2 ± 5.9%, P = 0.62; and longitudinal -20.7 ± 4.1% versus -18.5 ± 5.4%, P = 0.19. An average radial strain <25% presented 100% sensitivity, 48% specificity, 6% positive predictive value, and 100% negative predictive value for the presence of 2R rejection (area under the curve 0.80, IC 95% 0.60-0.99, P = 0.048). CONCLUSION: In this study, HT recipients showed significantly lower values of average radial left ventricle strain, evaluated by means of 2DSTE, with the presence of ACR.

Long-term survival in elderly patients with stable coronary disease.

BACKGROUND: This study aimed to assess long-term prognosis of stable coronary artery disease (sCAD) in patients aged ≥ 75 years and to identify clinical predictors of cardiovascular and overall mortality. MATERIALS AND METHODS: From February 2000 to January 2007, 391 outpatients aged ≥ 75 years (median 78 years, interquartile range [IQR] 76-81 years, 66% male) with sCAD were recruited in this prospective cohort study. Associations of baseline variables with long-term cardiovascular and all-cause death were investigated. RESULTS: After up to 11 years of follow-up (median 4 years, IQR 2-6 years), 89 patients died (23%, 5·45%/year), 35 from cardiovascular causes (9%, 2·14%/year). Multivariate analysis identified family history of coronary disease (HR 4·28, 95% CI 1·22-15·02, P = 0·02), baseline atrial fibrillation (HR 3·18, 95% CI 1·37-7·39, P = 0·007), age (HR 1·61 per 5 year increase, 95% CI 1·04-2·50, P = 0·03), resting heart rate (HR 1·26 per 5 bpm increase, 95% CI 1·09-1·47, P = 0·003) and previous revascularization (HR 0·17, 95% CI 0·04-0·77, P = 0·02) as independent predictors of cardiovascular death, and previous acute coronary syndrome (HR 4·93, 95% CI 1·49-16·30, P = 0·009), baseline atrial fibrillation (HR 1·96, 95% CI 1·12-3·43, P = 0·02), tobacco use (HR 1·69, 95% CI 1·00-2·84, P = 0·049 for ex-smoking and HR 6·78, 95% CI 0·89-51·47, P = 0·06 for active smoking), age (HR 1·58 per 5 year increase, 95% CI 1·18-2·11, P = 0·002), resting heart rate (HR 1·10 per 5 bpm increase, 95% CI 1·00-1·22, P = 0·05) and diastolic blood pressure (HR 0·97, 95% CI 0·94-0·99, P = 0·01) as independent predictors of overall mortality. CONCLUSIONS: In this study, 4-years overall mortality was 23% among elderly patients with sCAD. Simple clinical variables can identify patients at higher risk of mortality.

Prognostic impact of baseline low blood pressure in hypertensive patients with stable coronary artery disease of daily clinical practice.

The authors' aim was to investigate the prognostic value of first-visit systolic and diastolic blood pressure (SBP/DBP) in hypertensive patients with stable coronary artery disease (sCAD) in conditions of contemporary daily clinical practice. From February 1, 2000, to January 31, 2004, 690 consecutive hypertensive patients with sCAD (mean age 68 ± 10 years, 65% male) were prospectively followed in the outpatient cardiology clinic for major events (acute coronary syndrome, revascularization, stroke, heart failure, or death) and associations with baseline SBP/DBP were investigated. At first visit, median SBP/SDP were 130/75 mm Hg (interquartile range, 25-75; 120-140/70-80 mm Hg). After 25 months of follow-up (median), 19 patients died (2.8%); 10 from cardiovascular causes (1.5%), 87 patients experienced a coronary event (13%), and 130 patients (19%) a major event. After adjusting for baseline variables, DBP <75 mm Hg or SBP <130 mm Hg resulted in independent predictors of major events (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.07-2.16, P=.02; HR, 1.68; 95% CI, 1.18-2.40, P=.004, respectively), coronary events (HR, 1.78; 95% CI, 1.15-2.75, P=.009; HR, 1.84; 95% CI, 1.20-2.83, P=.005, respectively), and cardiovascular mortality (HR, 7.02; 95% CI, 1.26-39.04, P=.03; HR, 9.26; 95% CI, 1.33-64.32, P=.02, respectively). In this study, a low first-visit SBP or DBP was associated with an adverse prognosis in hypertensive patients with sCAD of contemporary daily clinical practice.

Etiologic spectrum and clinical features of mitral regurgitation in a Spanish population.

BACKGROUND AND AIM OF THE STUDY: The study aim was to investigate the etiologic spectrum of at least moderate mitral regurgitation (MR) in patients at a tertiary care center in a Spanish region. METHODS: All patients referred for echocardiography with moderate or severe MR, assessed according to the guidelines of the American Society of Echocardiography, were included prospectively in the study. RESULTS: Between October 2006 and February 2008, a total of 276 patients (157 females, 119 males; mean age 61 +/- 20 years) were enrolled into the study. At the time of evaluation, 67% of the patients were outpatients and the remainder were hospitalized. The NYHA functional class was III-IV in 31% of patients. The main echocardiographic data were: color flow jet area 11 +/- 5 cm2, vena contracta 6.7 +/- 1.9 mm, effective regurgitant orifice area 0.46 +/- 0.28 cm2, left ventricular diastolic and systolic diameters 58 +/- 10 mm and 39 +/- 12 mm, respectively, left ventricular ejection fraction 0.55 +/- 0.19, and pulmonary artery systolic pressure 39 +/- 16 mmHg. The MR was degenerative in 42% of patients, rheumatic in 22%, functional due to idiopathic dilated cardiomyopathy in 18%, functional due to ischemic cardiomyopathy in 7%, congenital in 7%, and had other causes in 4%. CONCLUSION: Among this Spanish population, the majority of the moderate or severe MR encountered was organic, with degenerative mitral disease as the most common etiology. Functional regurgitation was present in a significant proportion of patients, with idiopathic dilated cardiomyopathy being the most frequent cause.

Efectividad de la anticoagulación oral en la fibrilación auricular no valvular según el score CHA2DS2-VASc en pacientes con riesgo embólico bajo-intermedio / Effectiveness of oral anticoagulation in nonvalvular atrial fibrillation according to CHA 2DS2-VASc score in patients with low-moderate embolic risk

No disponible

Outcomes and safety of antithrombotic treatment in patients aged 80 years or older with nonvalvular atrial fibrillation.

Our aim was to evaluate the effectiveness of oral anticoagulation (OAC) in patients aged ≥80 years with nonvalvular atrial fibrillation in daily clinical practice. From February 1, 2000 to June 30, 2009, we enrolled all patients aged ≥80 years with nonvalvular atrial fibrillation attended at 2 outpatient cardiology clinics of a tertiary care university hospital. The patients received antithrombotic treatment according to the recommendations from scientific societies and were prospectively followed, with major events (i.e., all-cause death, stroke, transient ischemic attack, peripheral embolism, severe bleeding) analyzed according to the treatment group (OAC vs no OAC). Of 269 patients included in the present study (87 men, mean age 83 ± 3 years), 164 received OAC (61%). After 2.8 ± 1.9 years of follow-up, the raw rates (per 100 patient-years) of embolic events (1.52% vs 8.30%, p <0.0001) and mortality (6.67% vs 10.94%, p = 0.04) were lower for patients receiving OAC, with a nonsignificant greater rate of severe bleeding (3.03% vs 1.25%, p = 0.14). The probability of survival free of major embolic or hemorrhagic events at the mean follow-up was greater for patients receiving OAC (82.27% vs 66.10%, p = 0.004). After adjustment for age, gender, coronary heart disease, and embolic risk, evaluated using the CHADS(2) score (congestive heart failure, 1 point; hypertension [blood pressure consistently >140/90 mm Hg or hypertension medication], 1 point; age ≥75 years, 1 point; diabetes mellitus, 1 point; previous stroke or transient ischemic attack, 2 points), only OAC was an independent predictor of embolic events (hazard ratio 0.17, 95% confidence interval 0.07 to 0.41, p <0.001). The CHADS(2) score (hazard ratio 1.32, 95% confidence interval 1.01 to 1.73, p = 0.04) and OAC (hazard ratio 0.52, 95% confidence interval 0.31 to 0.88, p = 0.01) were independent predictors of mortality. In conclusion, OAC according to the scientific societies' recommendations is effective and safe in daily clinical practice, even in patients aged ≥80 years.

Prognostic value of resting heart rate in a broad population of patients with stable coronary artery disease: prospective single-center cohort study.

INTRODUCTION AND OBJECTIVES: Our aim was to investigate the prognostic value of the resting heart rate (RHR) in a broad unselected population of patients with stable coronary artery disease (sCAD). METHOD: Between February 1, 2000 and January 31, 2004, 1264 ambulatory patients with sCAD were recruited into the prospective study. Patients were followed up for major events (i.e. death, acute coronary syndrome, coronary revascularization, stroke, and hospitalization for heart failure). Associations between these events and the RHR (i.e. ≥ 70 beats per minute [bpm] versus < 70 bpm) were evaluated. RESULTS: The patients' median age was 68 years (interquartile range [IQR] 60-74 years) and 926 (73%) were male. The RHR was ≥ 70 bpm in 645 patients (51%) and < 70 bpm in 619 (49%). After a median follow-up period of 25 months (IQR 12-39 months), with only seven patients lost to follow-up, the probability of an event was 17.48% in patients with an RHR ≥ 70 bpm and 17.67% in those with an RHR < 70 bpm (P =. 32) and total mortality was 2.32% and 2.5%, respectively (P = .56). After adjustment for age, sex, cardiovascular risk factors, blood pressure, baseline cardiac rhythm, ejection fraction and treatment at first visit, no significant association was found between the RHR and major events (hazard ratio [HR] = 1.04; 95% confidence interval [CI], 0.76-1.43; P = .79) or mortality (HR = 1.24; 95% CI, 0.55-2.81; P=.61). CONCLUSIONS: The RHR was not an adverse prognostic factor in this group of unselected patients with sCAD. The prognostic value of the RHR in daily clinical practice could be low in this population.

Valor pronóstico de la frecuencia cardiaca en reposo en una población general de pacientes con cardiopatía isquémica crónica: un estudio prospectivo, monocéntrico de cohortes / Prognostic value of resting heart rate in a broad population of patients with stable coronary artery disease: prospective single- center cohort study

Introducción y objetivos. Nuestro objetivo es evaluar el valor pronóstico de la frecuencia cardiaca en reposo (FCr) en una población general no seleccionada de pacientes con cardiopatía isquémica crónica (CIC). Métodos. Del 1 de febrero de 2000 al 31 de enero de 2004, se incluyó prospectivamente a 1.264 pacientes ambulatorios con CIC, y se los siguió para eventos mayores (mortalidad, síndrome coronario agudo, revascularización coronaria, ictus e ingreso por insuficiencia cardiaca) para evaluar la asociación de éstos con la FCr (≥ 70 frente a < 70 lat/min). Resultados. La mediana [p25-p75] de edad fue 68 [60- 74] años, y 926 pacientes eran varones (73%); 645 pacientes (51%) presentaron una FCr ≥ 70 lat/min y 619 (49%), FCr < 70 lat/min. Tras una mediana de seguimiento de 25 [12-39] meses, con sólo 7 pacientes perdidos, la probabilidad de eventos fue del 17,48% en pacientes con FCr ≥ 70 lat/min y del 17,67% en pacientes con FCr < 70 lat/min (p = 0,32) y la mortalidad total, del 2,32 y el 2,5% respectivamente (p = 0,56). Tras ajustar por edad, sexo, factores de riesgo cardiovascular, presión arterial, ritmo basal, fracción de eyección y tratamiento en la primera visita, no encontramos asociación entre la FCr y la tasa de eventos mayores (hazard ratio [HR] = 1,04; intervalo de confianza [IC] del 95%, 0,76-1,43; p = 0,79) o la mortalidad total (HR = 1,24; IC del 95%, 0,55-2,81; p = 0,61). Conclusiones. La FCr no ha sido un factor pronóstico adverso en esta muestra no seleccionada de pacientes con CIC. La importancia pronóstica de la FCr en la práctica clínica habitual podría ser baja en esta población (AU)

Introductions and objectives. Our aim was to investigate the prognostic value of the resting heart rate (RHR) in a broad unselected population of patients with stable coronary artery disease (sCAD). Method. Between February 1, 2000 and January 31, 2004, 1264 ambulatory patients with sCAD were recruited into the prospective study. Patients were followed up for major events (i.e. death, acute coronary syndrome, coronary revascularization, stroke, and hospitalization for heart failure). Associations between these events and the RHR (i.e. ≥70 beats per minute [bpm] versus <70 bpm) were evaluated. Results. The patients’ median age was 68 years (interquartile range [IQR] 60-74 years) and 926 (73%) were male. The RHR was ≥70 bpm in 645 patients (51%) and <70 bpm in 619 (49%). After a median follow-up period of 25 months (IQR 12-39 months), with only seven patients lost to follow-up, the probability of an event was 17.48% in patients with an RHR ≥70 bpm and 17.67% in those with an RHR <70 bpm (P=.32) and total mortality was 2.32% and 2.5%, respectively (P=.56). After adjustment for age, sex, cardiovascular risk factors, blood pressure, baseline cardiac rhythm, ejection fraction and treatment at first visit, no significant association was found between the RHR and major events (hazard ratio [HR]=1.04; 95% confidence interval [CI], 0.76-1.43; P=.79) or mortality (HR=1.24; 95% CI, 0.55-2.81; P=.61). Conclusions. The RHR was not an adverse prognostic factor in this group of unselected patients with sCAD. The prognostic value of the RHR in daily clinical practice could be low in this population (AU)

Autograft failure during follow-up after the Ross procedure: predictive factors in a prospective series.

To determine the incidence of, and predictive factors for, aortic autograft failure during follow-up after the Ross procedure. Of 102 consecutive patients who underwent surgery at our centre between 1997 and 2009, we selected 83 (age 32+/-11 years), all of whom had been discharged without significant autograft regurgitation and for whom at least one follow-up echocardiogram was available. Autograft failure was defined as the presence of at least moderate regurgitation on echocardiography. After a median follow-up period of 4.2 years (range 0.2-10.9 years), eight patients (9.6%) developed this complication, three of whom required valve replacement. The probability of survival without autograft failure at 5 years was 90% (95% confidence interval [CI] 83%-98%). Multivariate analysis showed that undergoing surgery during the first 6 months of the learning curve (hazard ratio = 9.1; 95% CI, 1.4-59.4; P=.021) and a large pulmonary annulus size, normalized by body surface area, (hazard ratio = 1.4; 95% CI, 1.016-1.924; P=.04) were independent predictors of this complication.

Insuficiencia del autoinjerto durante el seguimiento tras la intervención de Ross: factores predictores en una serie prospectiva / Autograft failure during follow-up after the ross procedure: predictive factors in a prospective series

Para analizar la incidencia y los factores predictores de la insuficiencia del autoinjerto aórtico durante el seguimiento tras la intervención de Ross, de 102 pacientes operados consecutivamente en nuestro centro entre 1997 y 2009, se seleccionó a 83 (media de edad, 32 ± 11 años) sin regurgitación significativa del autoinjerto al alta y con al menos un ecocardiograma de seguimiento. La insuficiencia del autoinjerto se definió como aquella al menos moderada por ecocardiografía. Tras una mediana (intervalo) de 4,2 (0,2-10,9) años de seguimiento, 8 (9,6%) pacientes presentaron esta complicación (3 precisaron sustitución valvular). La probabilidad de supervivencia libre de insuficiencia del autoinjerto fue del 90% (intervalo de confianza [IC] del 95%, 83%-98%) a los 5 años. En el análisis multivariable, la intervención en los primeros 6 meses de la curva de aprendizaje (hazard ratio [HR] = 9,1; IC del 95%, 1,4-59,4; p = 0,021) y el mayor tamaño del anillo pulmonar (normalizado para la superficie corporal, HR = 1,4; IC del 95%, 1,016-1,924; p = 0,04) fueron predictores independientes de esta complicación (AU)

To determine the incidence of, and predictive factors for, aortic autograft failure during follow-up after the Ross procedure. Of 102 consecutive patients who underwent surgery at our centre between 1997 and 2009, we selected 83 (age 32±11 years), all of whom had been discharged without significant autograft regurgitation and for whom at least one follow-up echocardiogram was available. Autograft failure was defined as the presence of at least moderate regurgitation on echocardiography. After a median follow-up period of 4.2 years (range 0.2-10.9 years), eight patients (9.6%) developed this complication, three of whom required valve replacement. The probability of survival without autograft failure at 5 years was 90% (95% confidence interval [CI] 83%-98%). Multivariate analysis showed that undergoing surgery during the first 6 months of the learning curve (hazard ratio = 9.1; 95% CI, 1.4-59.4; P=.021) and a large pulmonary annulus size, normalized by body surface area, (hazard ratio = 1.4; 95% CI, 1.016-1.924; P=.04) were independent predictors of this complication (AU)

Oral anticoagulation in nonvalvular atrial fibrillation in clinical practice: impact of CHADS(2) score on outcome.

OBJECTIVES: CHADS(2) score predicts embolic risk in patients with nonvalvular atrial fibrillation (NVAF), but also bleeding risk in patients receiving oral anticoagulation (OAC). Our objective is to analyze the effectiveness and safety of OAC in patients with NVAF in daily clinical practice, according to embolic risk evaluated by means of CHADS(2) score. METHODS: All consecutive outpatients with permanent NVAF seen at 2 cardiology clinics were prospectively followed for embolic events (transient ischemic attack, ischemic stroke, peripheral embolism) and severe bleedings. OAC was prescribed according to the recommendations of scientific associations. CHADS(2) score was obtained for each patient. RESULTS: From February 1, 2000 to July 31, 2003, 796 outpatients fulfilled the inclusion criteria. OAC was prescribed to 564 (71%) patients. After 2.4 +/- 1.9 years of follow-up, the embolic event rates (per 100 patient-years) for each stratum of the CHADS(2 )score for patients with/without OAC were: 1/4.1, p = 0.23 (CHADS(2) = 0); 0.6/7.1, p = 0.0018 (CHADS(2) = 1); 0.5/5.1, p = 0.0014 (CHADS(2) = 2); 2.4/12.5, p = 0.0017 (CHADS(2) = 3) and 2.9/20, p = 0.013 (CHADS(2) >or=4). The severe bleeding rates for the same CHADS(2) score strata were 3/0.8, 0.8/0.7, 1.3/0.7, 0.4/0, and 2.9/5 in patients with/without OAC (n.s.). CONCLUSION: OAC is effective and safe in daily clinical practice in patients with NVAF and CHADS(2) score >or=1.

[Predicting embolic events in patients with nonvalvular atrial fibrillation: evaluation of the CHADS2 score in a Mediterranean population]. / Predicción de eventos embólicos en pacientes con fibrilación auricular no valvular: evaluación del score CHADS2 en una población mediterránea.

INTRODUCTION AND OBJECTIVES: A new index for predicting embolic risk in nonvalvular atrial fibrillation has been proposed, the CHADS2 score, which is calculated by adding 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes, and by adding 2 points for a history of stroke or transient ischemic attack (TIA). Our objective was to evaluate the use of this score in a Mediterranean population. METHODS: Between February 1st, 2000 and December 20th, 2006, all patients with permanent nonvalvular atrial fibrillation being treated at two outpatient cardiology clinics in a university hospital in the south of Spain were offered antithrombotic therapy in accordance with scientific society recommendations and were prospectively monitored for embolic events (i.e., stroke, TIA or peripheral embolism). A CHADS2 score was derived for each of the 296 patients who did not receive anticoagulation. RESULTS: The CHADS2 score was 0 in 69 (23.3%) patients, 1 in 81 (27.4%), 2 in 99 (33.4%), 3 in 30 (10.1%), and 4 or more in 17 (5.7%). After 21 (17) months of follow-up, the embolic event rates for CHADS2 scores of 0, 1, 2, 3, and > or =4 were 2.88, 5.80, 5.16, 14.78 and 22.02 per 100 patient-years, respectively (P=.0016). Patients with a CHADS2 score from 0-2 had an embolic rate of 4.63 per 100 patient-years, compared with 17.31 per 100 patient-years in those with a score > or =3 (P=.00087). CONCLUSIONS: The CHADS2 score proved useful for quantifying the risk of an embolic event in Mediterranean patients with nonvalvular atrial fibrillation. In our series, the risk of embolism in patients with a low score was not negligible.

[Clinical characteristics and prognosis of infective endocarditis in women]. / Características clínicas y pronóstico de la endocarditis infecciosa en la mujer.

INTRODUCTION AND OBJECTIVES: Little is known about the prognosis of infective endocarditis in women. The objective of this study was to determine the clinical characteristics and prognosis of infective endocarditis in women diagnosed with the condition at our center during the last 20 years. METHODS: Comparative analysis of 288 patients diagnosed with infective endocarditis between 1987 and 2006. Of these, 104 (36%) were women. RESULTS: Mean age was similar in the two sexes, at 50 (18) years for men and 52 (21) years for women, as was the incidence of early and late prosthetic valve endocarditis: the incidence of early prosthetic endocarditis was 42% in men and 49% in women. Infection occurred more frequently in the mitral valve in women (54% vs. 39%) and more frequently in the aortic valve in men (50% vs. 29%; P< .01). The severe complication rate during the active disease phase was similar in the two sexes (76% for women and 73% for men). Fewer women underwent surgery during the active disease phase (44% versus 58%; P< .03), and there was a trend to higher mortality in women (24% versus 20.7%; (24% versus 20.7%; P<.1). The 5-year survival rate was similar in the two sexes, at 85% in men and 83% in women. CONCLUSIONS: The clinical characteristics of infective endocarditis were similar in men and women. However, women underwent surgery less frequently despite a similar rate of severe complications during the active disease phase.

Predicción de eventos embólicos en pacientes con fibrilación auricular no valvular: evaluación del score CHADS2 en una población mediterránea / Predicting embolic events in patients with nonvalvular atrial fibrillation: evaluation of the CHADS2 score in a mediterranean population

Introducción y objetivos. Para predecir el riesgo cardioembólico en la fibrilación auricular no valvular (FANV) se ha propuesto un nuevo índice, el CHADS2, que se conforma asignando 1 punto por la presencia de insuficiencia cardiaca, hipertensión, edad ≥ 75 años o diabetes y 2 puntos si hay historia de ictus o accidente isquémico transitorio (AIT). Nuestro objetivo es evaluar este índice en una población mediterránea. Métodos. Del 1 de febrero de 2000 al 20 de diciembre de 2006, a todos los pacientes con FANV permanente atendidos en dos consultas de cardiología de un hospital del sur de España, se les indicó terapia antitrombótica según las recomendaciones de las sociedades científicas. Se siguió prospectivamente la aparición de eventos embólicos (ictus, AIT o embolia periférica). El índice CHADS2 fue aplicado a los 296 pacientes que no fueron anticoagulados. Resultados. El índice CHADS2 fue 0 en 69 (23,3%) pacientes, 1 en 81 (27,4%), 2 en 99 (33,4%), 3 en 30 (10,1%) y ≥ 4 en 17 (5,7%). Tras 21 ± 17 meses de seguimiento, la tasa de eventos embólicos según su índice CHADS2 fuera 0, 1, 2, 3 o ≥ 4 fue de 2,88, 5,80, 5,16, 14,78 y 22,02 cada 100 pacientes/año, respectivamente (p = 0,0016). Los pacientes con índice CHADS2 0-2 presentaron una tasa de embolias de 4,63, frente a 17,31/100 pacientes/año en aquellos con índices ≥ 3 (p = 0,00087). Conclusiones. El índice CHADS2 es válido para cuantificar el riesgo de eventos embólicos en una población mediterránea de pacientes con FANV. En nuestra serie, el riesgo embólico en pacientes con índice bajo no es despreciable (AU)

Introduction and objectives. A new index for predicting embolic risk in nonvalvular atrial fibrillation has been proposed, the CHADS2 score, which is calculated by adding 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes, and by adding 2 points for a history of stroke or transient ischemic attack (TIA). Our objective was to evaluate the use of this score in a Mediterranean population. Methods. Between February 1st, 2000 and December 20th, 2006, all patients with permanent nonvalvular atrial fibrillation being treated at two outpatient cardiology clinics in a university hospital in the south of Spain were offered antithrombotic therapy in accordance with scientific society recommendations and were prospectively monitored for embolic events (i.e., stroke, TIA or peripheral embolism). A CHADS2 score was derived for each of the 296 patients who did not receive anticoagulation. Results. The CHADS2 score was 0 in 69 (23.3%) patients, 1 in 81 (27.4%), 2 in 99 (33.4%), 3 in 30 (10.1%), and 4 or more in 17 (5.7%). After 21 (17) months of follow-up, the embolic event rates for CHADS2 scores of 0, 1, 2, 3, and ≥4 were 2.88, 5.80, 5.16, 14.78 and 22.02 per 100 patient-years, respectively (P=.0016). Patients with a CHADS2 score from 0­2 had an embolic rate of 4.63 per 100 patient-years, compared with 17.31 per 100 patient-years in those with a score ≥3 (P=.00087). Conclusions. The CHADS2 score proved useful for quantifying the risk of an embolic event in Mediterranean patients with nonvalvular atrial fibrillation. In our series, the risk of embolism in patients with a low score was not negligible (AU)

Características clínicas y pronóstico de la endocarditis infecciosa en la mujer / Clinical characteristics and prognosis of infective endocarditis in women

Introducción y objetivos. El pronóstico de la endocarditis infecciosa en la mujer ha sido poco estudiado. El objetivo del presente estudio es analizar las características clínicas y el pronóstico de las mujeres con endocarditis infecciosa atendidas en nuestra institución en los últimos 20 años. Métodos. Análisis comparativo de 288 pacientes con endocarditis infecciosa desde 1987 hasta 2006. De ellos, 104 (36%) eran mujeres. Resultados. La media de edad fue similar en ambos grupos (50 ± 18 años los varones y 52 ± 21 las mujeres), así como la incidencia de endocarditis sobre prótesis precoz y tardía (endocarditis protésica precoz: varones, 42%; mujeres, 49%). La infección se localizó con mayor frecuencia en la válvula mitral en las mujeres (el 54 frente al 39%) y en la válvula aórtica en los varones (el 50 frente al 29%; p < 0,01). La tasa de complicaciones severas durante la fase activa fue similar en ambos grupos (el 73% en varones y el 76% en mujeres). Se intervino a mujeres con menor frecuencia durante la fase activa de la enfermedad (el 44 frente al 58%; p < 0,03) y hubo una tendencia a una mayor mortalidad precoz en las mujeres que en los varones (el 24 frente al 20,7%; p < 0,1). La supervivencia a los 5 años fue similar en ambos grupos (el 85% en los varones y el 83% en las mujeres). Conclusiones. Las características clínicas de la endocarditis infecciosa son similares en varones y mujeres; sin embargo, las mujeres se operan con menor frecuencia a pesar de una tasa similar de complicaciones severas durante la fase activa (AU)

Introduction and objectives. Little is known about the prognosis of infective endocarditis in women. The objective of this study was to determine the clinical characteristics and prognosis of infective endocarditis in women diagnosed with the condition at our center during the last 20 years. Methods. Comparative analysis of 288 patients diagnosed with infective endocarditis between 1987 and 2006. Of these, 104 (36%) were women. Results. Mean age was similar in the two sexes, at 50 (18) years for men and 52 (21) years for women, as was the incidence of early and late prosthetic valve endocarditis: the incidence of early prosthetic endocarditis was 42% in men and 49% in women. Infection occurred more frequently in the mitral valve in women (54% vs. 39%) and more frequently in the aortic valve in men (50% vs. 29%; P<.01). The severe complication rate during the active disease phase was similar in the two sexes (76% for women and 73% for men). Fewer women underwent surgery during the active disease phase (44% versus 58%; P<.03), and there was a trend to higher mortality in women (24% versus 20.7%; P<.1). The 5-year survival rate was similar in the two sexes, at 85% in men and 83% in women. Conclusions. The clinical characteristics of infective endocarditis were similar in men and women. However, women underwent surgery less frequently despite a similar rate of severe complications during the active disease phase (AU)

Pacemaker-related endocarditis: clinical features and treatment.

BACKGROUND AND AIM OF THE STUDY: Removal of the entire infected system is the traditionally indicated management of pacemaker lead endocarditis (PLE), based on expert recommendations. Herein is described the present authors' experience with this condition. METHODS: Between 1987 and 2004, all consecutive patients with PLE treated at a tertiary referral university hospital and a community hospital were prospectively selected. Clinical features, management and outcome were analyzed. RESULTS: Thirteen cases of PLE were diagnosed. Surgery was performed in 10 cases, and medical treatment alone in three (due to advanced age in two cases and because of terminal colon cancer in one case). Four subjects died before discharge: three deaths occurred after surgery (one patient died due to refractory ventricular arrhythmia and two from persistent sepsis), and one unoperated patient died from sepsis and severe renal failure. No deaths or late surgeries were observed after a mean follow up period of 37 +/- 14 months. Both patients who survived hospitalization and underwent only medical treatment were free from late complications after 30 and 60 months follow up, respectively. CONCLUSION: Some patients with PLE present a good evolution without surgery, suggesting that surgical treatment is not mandatory in this situation. However, an indication for surgery may be similar to that for other cases of infective endocarditis.

Clinical features and outcome of non-drug-addicted patients with infective endocarditis and perivalvular abscess.

BACKGROUND AND AIM OF THE STUDY: Perivalvular abscess is a serious complication in infective endocarditis (IE) that confers a poor prognosis. Few data are available concerning the long-term outcome of these patients. The study aim was to determine clinical features and long-term prognosis of non-drug addict patients with IE complicated by perivalvular abscess. METHODS: Among a consecutive series of 241 patients with IE, 30 (12.4%) were diagnosed with perivalvular abscess and treated at the authors' institution over a 15-year period. A comparative analysis of patients with perivalvular abscess and other patients in the series was performed. RESULTS: Perivalvular abscess was more frequently associated with aortic valve endocarditis (93% versus 35%, p <0.05), and Streptococcus sp. was the predominant microorganism. Severe complications during hospital admission were more common in patients with perivalvular abscess (100% versus 61%, p <0.01). In-hospital mortality was significantly higher in patients with perivalvular abscess (33% versus 15%, p <0.05). Event-free survival at five years among survivors of the in-hospital phase was 86% in patients with perivalvular abscess, and 83% in those without abscess (p = NS). CONCLUSION: Patients with IE and perivalvular abscess have a higher in-hospital mortality rate, as major complications are more common in these patients. However, among patients who survived the active phase of the disease, long-term survival was similar with or without perivalvular abscess.

[Short-term results with the ross procedure. Does the etiology of aortic valvulopathy affect the outcome?]. / Resultados a corto plazo en la técnica de Ross. Influye la etiología de la valvulopatía aórtica?

INTRODUCTION: The Ross procedure has become established as an appropriate method for aortic valve replacement in children and young adults. There is controversy regarding the results of this surgical technique depending on whether the aortic valve disorder is congenital or acquired. The objective of this study was to analyze the outcome of this technique in different etiologies. PATIENTS AND METHOD: We analyzed 61 patients who underwent the Ross procedure between November 1997 and November 2001. Age range was 6 to 54 years, and 44 patients (72%) were male. The mean duration of follow-up was 15.6 (10.6) months. The aortic valve lesion was stenosis in 17 patients, regurgitation in 22 and both in 22. The patients were divided into two groups: etiology was congenital in group I (40 patients) and acquired in group II (21 patients: 14 rheumatic, 2 degenerative, 2 endocarditis and 3 other). RESULTS: Pre-intervention data showed significant differences in age, functional class and percentage of patients with previous cardiac surgery. In the last follow-up examination, autograft gradient and homograft gradient were similar in both groups. Diastolic and systolic diameters and left ventricle ejection fraction were normal in both groups and did not differ between groups. Major events during follow-up were: 1 patient died, 1 patient had endocarditis, and 2 patients needed stent implantation in the homograft in group I; 2 patients in group II underwent reoperation because of severe autograft dysfunction. There were no statistically significant differences between groups. CONCLUSION: Short-term morbidity and mortality associated with the Ross procedure are low in patients with either congenital or acquired aortic valvulopathy.