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1.
Reumatol. clín. (Barc.) ; 20(2): 104-107, Feb. 2024. ilus
Artigo em Espanhol | IBECS | ID: ibc-230146

RESUMO

Se presenta el caso de femenino de 36 años con antecedentes de granulomatosis con poliangítis; enfermedad renal crónica e hipertensión arterial sistémica. Debutó con disnea, debilidad y hemoptisis, se sospechó en neumonía atípica, descartándose, persistiendo con taquipnea, taquicardia, dolor torácico. Se inició protocolo para tuberculosis pulmonar con muestras de esputo negativas, hemocultivo positivo para S. haemolyticus, tomografía de tórax con neumotórax izquierdo y derrame pleural ipsilateral, se obtuvo líquido pleural tipo exudado, tinción ácido alcohol-resistente y reacción en cadena de la polimerasa (PCR) para M. tuberculosis negativas; se realizó ecocardiograma de rastreo por soplo de nueva aparición, reportando vegetación valvular, concluyendo diagnóstico de tuberculosis pleural y endocarditis como complicaciones de origen multifactorial asociado a inmunosupresión en granulomatosis con poliangítis.(AU)


We present the case of a 36-year-old woman with a history of granulomatosis with polyangiitis, chronic kidney disease, and systemic arterial hypertension. Debut with dyspnea, weakness, and hemoptysis, she was suspected in atypical pneumonia, discarded, persisting with tachypnea, tachycardia, and chest pain. The protocol for pulmonary tuberculosis was started with negative sputum samples, positive blood culture for Staphylococcus haemolyticus, chest tomography with left pneumothorax and ipsilateral pleural effusion, exudate-type pleural fluid was obtained, acid-fast staining, negative PCR for Mycobacterium tuberculosis. A follow-up echocardiogram was performed due to a new murmur, reporting valvular vegetation, concluding a diagnosis of pleural tuberculosis and endocarditis as complications of multifactorial origin associated with immunosuppression in granulomatosis with polyangiitis.(AU)


Assuntos
Humanos , Feminino , Adulto , Tuberculose Pleural/diagnóstico , Endocardite/complicações , Granulomatose com Poliangiite , Hipertensão , Insuficiência Renal Crônica/complicações , Tomografia Computadorizada por Raios X , Reumatologia , Doenças Reumáticas , Pacientes Internados , Exame Físico , Avaliação de Sintomas
3.
J Cardiothorac Surg ; 19(1): 49, 2024 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-38310253

RESUMO

BACKGROUND: Right-sided infective endocarditis (RSIE) is a relatively uncommon condition which is difficult to distinguish from thrombus, particularly when the site of infection or the patient's symptoms are atypical. There have been few reports exploring the differential diagnostic and analytical features between RSIE and thrombus. CASE PRESENTATION: Here, we presented two cases of RSIE-one involving the tricuspid valve and the other affecting the pulmonary artery. Notably, the second case was initially misdiagnosed as thrombus based on the findings of by computed tomography angiography(CTA). CONCLUSIONS: Vegetation and thrombus can be distinguished according to the nature of the mass, its attachment location, and the clinical manifestation. Echocardiography can observe both the location and size of the mass, and the dynamic changes in cardiac hemodynamics and cardiac morphology, thereby facilitating an effective distinction between vegetation and thrombus.


Assuntos
Endocardite Bacteriana , Endocardite , Trombose , Humanos , Endocardite/diagnóstico por imagem , Ecocardiografia , Valva Tricúspide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Trombose/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem
4.
BMJ Case Rep ; 17(2)2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38350700

RESUMO

We describe two patients, in their 70s, each presenting to the emergency department, with 6-week histories of progressively developing pruritic bullae. Both individuals had multiple comorbidities, including type 2 diabetes-for which they took linagliptin, chronic kidney disease, hypertension and prosthetic heart valves. Owing to systemic illness and endocarditis secondary to superadded bacterial infections, they both required intensive treatment and prolonged hospital admissions.Despite the beneficial effect of linagliptin on glycaemic control and its reported cardiovascular and renal safety profiles, we add our cases as evidence of the significant risk of developing bullous pemphigoid while taking this medication. Secondary infection of bullous pemphigoid increased the risk of developing endocarditis, particularly among individuals with a medical history of valve replacement surgery. Considering this, we advocate caution when prescribing this medication.


Assuntos
Diabetes Mellitus Tipo 2 , Endocardite , Penfigoide Bolhoso , Sepse , Humanos , Linagliptina/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/tratamento farmacológico , Sepse/complicações , Sepse/tratamento farmacológico
5.
Radiographics ; 44(3): e230031, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38329903

RESUMO

Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic device. The clinical presentation of patients with IE varies, ranging from acute and rapidly progressive symptoms to a more chronic disease onset. Because of its severe morbidity and mortality rates, it is necessary for radiologists to maintain a high degree of suspicion in evaluation of patients for IE. Modified Duke criteria are used to classify cases as "definite IE," "possible IE," or "rejected IE." However, these criteria are limited in characterizing definite IE in clinical practice. The use of advanced imaging techniques such as cardiac CT and nuclear imaging has increased the accuracy of these criteria and has allowed possible IE to be reclassified as definite IE in up to 90% of cases. Cardiac CT may be the best choice when there is high clinical suspicion for IE that has not been confirmed with other imaging techniques, in cases of IE and perivalvular involvement, and for preoperative treatment planning or excluding concomitant coronary artery disease. Nuclear imaging may have a complementary role in prosthetic IE. The main imaging findings in IE are classified according to the site of involvement as valvular (eg, abnormal growths [ie, "vegetations"], leaflet perforations, or pseudoaneurysms), perivalvular (eg, pseudoaneurysms, abscesses, fistulas, or prosthetic dehiscence), or extracardiac embolic phenomena. The differential diagnosis of IE includes evaluation for thrombus, pannus, nonbacterial thrombotic endocarditis, Lambl excrescences, papillary fibroelastoma, and caseous necrosis of the mitral valve. The location of the lesion relative to the surface of the valve, the presence of a stalk, and calcification or enhancement at contrast-enhanced imaging may offer useful clues for their differentiation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.


Assuntos
Falso Aneurisma , Endocardite Bacteriana , Endocardite , Humanos , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/patologia , Endocardite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Imagem Multimodal
6.
BMC Med ; 22(1): 61, 2024 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-38331876

RESUMO

BACKGROUND: Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE). METHODS: In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis. RESULTS: In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3-8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1-5.4), coronary angiogram (HR = 4.0, 95% CI 2.3-7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3-4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8-8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5-4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1-1.5, p = 0.002). CONCLUSIONS: The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.


Assuntos
Endocardite , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Humanos , Masculino , Idoso , Feminino , Estudos de Coortes , Próteses Valvulares Cardíacas/efeitos adversos , Austrália/epidemiologia , Valvas Cardíacas , Endocardite/epidemiologia , Endocardite/etiologia , Infecções Relacionadas à Prótese/cirurgia
7.
Vet Res ; 55(1): 17, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321502

RESUMO

Streptococcus suis is a gram-positive bacterium that causes meningitis, septicemia, endocarditis, and other disorders in pigs and humans. We obtained 42 and 50 S. suis isolates from lesions of porcine endocarditis and palatine tonsils, respectively, of clinically healthy pigs in Japan; we then determined their sequence types (STs) by multilocus sequence typing (MLST), cps genotypes, serotypes, and presence of classical major virulence-associated marker genes (mrp, epf, and sly). The 42 isolates from endocarditis lesions were assigned to a limited number of STs and clonal complexes (CCs). On the other hand, the 50 isolates from tonsils were diverse in these traits and seemingly in the degree of virulence, suggesting that tonsils can accommodate a variety of S. suis isolates. The goeBURST full algorithm using tonsil isolates obtained in this study and those retrieved from the database showed that major CCs as well as many other clusters were composed of isolates originating from different countries, and some of the STs were very similar to each other despite the difference in country of origin. These findings indicate that S. suis with not only different but also similar mutations in the genome have survived in tonsils independently across different geographical locations. Therefore, unlike the lesions of endocarditis, the tonsils of pigs seemingly accommodate various S. suis lineages. The present study suggests that S. suis acquired its diversity by natural mutations during colonization and persistence in the tonsils of pigs.


Assuntos
Endocardite , Infecções Estreptocócicas , Streptococcus suis , Doenças dos Suínos , Humanos , Suínos , Animais , Tipagem de Sequências Multilocus/veterinária , Tonsila Palatina/microbiologia , Streptococcus suis/genética , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/veterinária , Doenças dos Suínos/microbiologia , Endocardite/veterinária
8.
J Cardiothorac Surg ; 19(1): 79, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38336753

RESUMO

BACKGROUND: Cardiac papillary fibroelastoma is a rare benign tumor, which is often mistaken for a vegetation. Predominantly asymptomatic, it can cause life-threatening complications. Although rare, mobile papillary fibroelastoma movement between affected valves may hamper valve closure and damage the valve, leading to valvular regurgitation. Endothelial damage increases the risk of developing infective endocarditis. We report a rare case of a highly mobile papillary fibroelastoma originating from the atrial septum touching the mitral valve, leading to mitral regurgitation and, eventually, infective endocarditis. CASE PRESENTATION: A 26-year-old woman with suspected infective endocarditis was referred to us from a previous hospital after having experienced intermittent fever for a month. Before the fever, she had been experiencing exertional dyspnea. In addition, she had undergone a cesarean section two weeks before this admission. A transthoracic echocardiogram showed a mobile mass originating from the atrial septum touching the mitral valve with severe mitral regurgitation. Computed tomography revealed an occluded right profunda femoris artery with an embolus. Infective endocarditis associated with a mobile vegetation with high embolic risk was diagnosed, and urgent surgery was performed. Following the surgery, examinations revealed papillary fibroelastoma originating from the atrial septum and infective endocarditis of the mitral valve. The histopathological examination confirmed that a mass initially thought to be a mobile vegetation was a papillary fibroelastoma. The postoperative course was uneventful except for pericarditis. There has been no recurrence of infective endocarditis or papillary fibroelastoma. CONCLUSIONS: The highly mobile papillary fibroelastoma was thought to have caused both chronic mitral regurgitation and infective endocarditis. Mobile papillary fibroelastomas can cause endothelial damage to nearby valves and predispose patients to infective endocarditis.


Assuntos
Septo Interatrial , Fibroelastoma Papilar Cardíaco , Endocardite Bacteriana , Endocardite , Fibroma , Neoplasias Cardíacas , Insuficiência da Valva Mitral , Gravidez , Humanos , Feminino , Adulto , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Valva Mitral/patologia , Insuficiência da Valva Mitral/cirurgia , Fibroelastoma Papilar Cardíaco/complicações , Septo Interatrial/diagnóstico por imagem , Septo Interatrial/cirurgia , Cesárea/efeitos adversos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Fibroma/complicações , Fibroma/cirurgia
9.
Port J Card Thorac Vasc Surg ; 30(4): 59-62, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38345879

RESUMO

Q fever is an ubiquitous zoonosis caused by Coxiella burnetii, an intracellular bacterium that can produce acute or chronic infections in humans. These forms are characterized by different evolution, serological profile and treatment that must be very long to achieve a cure in chronic forms. However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. In this case report, we present a 20-year-old man from Nicaragua who worked as a farmer with a culture-negative infective endocarditis who presented with a mycotic aneurysm. The present report reviews the clinical presentation and diagnosis of Q fever IE.


Assuntos
Aneurisma Infectado , Coxiella burnetii , Endocardite , Aneurisma Intracraniano , Febre Q , Masculino , Humanos , Adulto Jovem , Adulto , Febre Q/complicações , Aneurisma Infectado/diagnóstico , Aneurisma Intracraniano/complicações
10.
Am J Case Rep ; 25: e942399, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38297824

RESUMO

BACKGROUND Candida prosthetic valve endocarditis is a rare disease that is increasing in incidence with the rising rates of fungemia and increased use of intracardiac devices. Chronic antifungal prophylaxis is used after primary treatment to prevent recurrence, but the optimal duration of prophylaxis is currently unknown. This case report is of a woman with a history of mitral valve replacement due to Candida endocarditis presenting 2 years later with prosthetic valve and native aortic valve Candida albicans endocarditis. CASE REPORT A 32-year-old woman with a history of intravenous drug abuse, Staphylococcus and Candida endocarditis, and 2 mitral valve replacements 2 years ago on long-term oral fluconazole presented with fevers, weight loss, and dyspnea. She had stopped taking her oral antifungals prior to presentation. She was found to have vegetations on her prosthetic mitral valve and on her native aortic valve. She was started on ceftriaxone, vancomycin, and micafungin, and blood cultures grew C. albicans. She also developed a C. albicans metatarsal abscess and a splenic infarct. She underwent redo mitral valve replacement and aortic valve debridement successfully and was continued on intravenous micafungin for 8 weeks. CONCLUSIONS This case highlights the association between prosthetic valve endocarditis, intravenous drug abuse, and opportunistic fungal infections. Lifelong oral fluconazole can be considered for all patients with C. albicans prosthetic valve endocarditis, especially in the setting of the presence of other risk factors, such as intravenous drug abuse, as demonstrated in our case. Further studies are needed to determine differences in outcomes.


Assuntos
Candidíase , Endocardite Bacteriana , Endocardite , Doenças das Valvas Cardíacas , Próteses Valvulares Cardíacas , Abuso de Substâncias por Via Intravenosa , Feminino , Humanos , Adulto , Candida albicans , Fluconazol/uso terapêutico , Micafungina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/microbiologia , Endocardite/microbiologia , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Doenças das Valvas Cardíacas/etiologia
11.
J Cardiothorac Surg ; 19(1): 41, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38308340

RESUMO

BACKGROUND: The extent of aortic valve inflammation in patients undergoing aortic valve replacement (AVR) is unsettled. The significance of aortic valve histopathology in patients undergoing AVR is undetermined. METHODS: A total of 145 resected aortic valves of consecutive patients undergoing surgery for a local aortic valve disease with or without ascending aorta were investigated for histopathology. The extent of inflammation and degeneration were investigated. Unadjusted survival was evaluated by Kaplan-Meier analysis. Median follow-up was 2.7 years (interquartile range 1.5-3.9). RESULTS: Mean patient age was 69 (SD 11) years. Though endocarditis was apparent in only six patients preoperatively, severe aortic valve inflammation was diagnosed histologically in 32 patients of whom 12 patients had acute, subacute or chronic endocarditis. Despite complete aortic valve resection, survival was decreased in patients with severe aortic valve inflammation as opposed to those without (log rank, P = 0.044), even after exclusion of patients with endocarditis, emergency and aortic surgery. CONCLUSIONS: Aortic valve tissue analysis reveals severe inflammation that may require postoperative treatment. The association of severe but local aortic valve inflammation with patient outcome after aortic valve surgery merits further investigation.


Assuntos
Endocardite , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Humanos , Idoso , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/complicações , Resultado do Tratamento , Endocardite/cirurgia , Inflamação , Estudos Retrospectivos
12.
BMC Cardiovasc Disord ; 24(1): 8, 2024 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-38166765

RESUMO

BACKGROUND: In hemodialysis (HD) patients, there is a larger frequency of mortality and morbidity associated with infective endocarditis (IE) as opposed to the general population. Despite the increased burden of IE in the HD population, optimal strategies for prevention and management still need to be clarified. Elucidating the distinguishing features and outcomes of IE in HD patients is crucial to guide clinical decision-making and improve prognosis in this high-risk group. However, the details of IE characteristics, specifically in HD patients in the Middle East, are limited. OBJECTIVE: To compare the clinical characteristics and short-term outcomes of IE between HD and non-HD patients. METHODS: A retrospective analysis was carried out on 139 patients with infective endocarditis who were referred to a tertiary cardiovascular center in Iran from 2006 to 2018. The participants were split into HD (n = 34) and non-HD (n = 105) groups. Data pertaining to demographic characteristics, comorbidities, microbiological findings, occurrence of complications, therapeutic interventions, and mortality rates during hospital stay were gathered. RESULTS: Diabetes, hypertension, and congestive heart failure were observed more frequently in HD patients. HD patients were more likely than non-HD patients to have involvement of the right valve (41.2% vs. 20.9%), larger vegetation, and extracardiac emboli. In-hospital mortality was 41.2% for HD patients versus 14.3% for non-HD patients. Mortality remained high after valve surgery in HD patients (38.2% vs. 10.5% in non-HD). CONCLUSION: HD patients exhibited a distinct clinical profile of IE with worse short-term outcomes, including higher mortality.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Estudos Retrospectivos , Irã (Geográfico)/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/terapia , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/terapia , Diálise Renal/efeitos adversos , Mortalidade Hospitalar , Fatores de Risco
13.
Artigo em Inglês | MEDLINE | ID: mdl-38193462

RESUMO

With the increasing use of cardiac implantable electronic devices, the number of patients with cardiac implantable electronic device-related endocarditis is also rising. The treatment of this type of endocarditis is a challenging clinical task, in particular if device removal is required in patients who are pacemaker dependent. This video tutorial describes a treatment strategy for cardiac implantable electronic device-related endocarditis involving the tricuspid valve in pacemaker-dependent patients. The proposed treatment strategy consists of implanting an epicardial pacemaker via a minimally invasive subxiphoid approach, percutaneous aspiration of tricuspid valve vegetations and complete transvenous explantation of the infected cardiac implantable electronic device system using advanced lead extraction tools.


Assuntos
Endocardite , Marca-Passo Artificial , Humanos , Endocardite/etiologia , Endocardite/cirurgia , Próteses e Implantes , Valva Tricúspide , Eletrônica , Marca-Passo Artificial/efeitos adversos
14.
J Cardiothorac Surg ; 19(1): 3, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38167451

RESUMO

BACKGROUND: This study examined the characteristics and outcomes of surgical aortic valve replacement (SAVR) both isolated and in combination with other cardiac surgery in Malaysia from 2015 to 2021. METHODS: This was a retrospective study of 1346 patients analyzed on the basis of medical records, echocardiograms and surgical reports. The overall sample was both considered as a whole and divided into aortic stenosis (AS)/aortic regurgitation (AR)-predominant and similar-severity subgroups. RESULTS: The most common diagnosis was severe AS (34.6%), with the 3 most common etiologies being bicuspid valve degeneration (45.3%), trileaflet valve degeneration (36.3%) and rheumatic valve disease (12.2%). The second most common diagnosis was severe AR (25.5%), with the most common etiologies being root dilatation (21.0%), infective endocarditis (IE) (16.6%) and fused prolapse (12.2%). Rheumatic valve disease was the most common mixed disease. A total of 54.5% had AS-predominant pathology (3 most common etiologies: bicuspid valve degeneration valve, degenerative trileaflet valve and rheumatic valve disease), 36.9% had AR-predominant pathology (top etiologies: root dilatation, rheumatic valve disease and IE), and 8.6% had similar severity of AS and AR. Overall, 62.9% of patients had trileaflet valve morphology, 33.3% bicuspid, 0.6% unicuspid and 0.3% quadricuspid. For AS, the majority were high-gradient severe AS (49.9%), followed by normal-flow low-gradient (LG) severe AS (10.0%), paradoxical low-flow (LF)-LG severe AS (6.4%) and classical LF-LG severe AS (6.1%). The overall in-hospital and total 1-year mortality rates were 6.4% and 14.8%, respectively. Pure severe AS had the highest mortality. For AS-predominant pathology, the etiology with the highest mortality was trileaflet valve degeneration; for AR-predominant pathology, it was dissection. The overall survival probability at 5 years was 79.5% in all patients, 75.7% in the AS-predominant subgroup, 83.3% in the AR-predominant subgroup, and 87.3% in the similar-severity subgroup. CONCLUSIONS: The 3 most common causes of AS- predominant patients undergoing SAVR is bicuspid valve degeneration, degenerative trileaflet valve and rheumatic and for AR-predominant is root dilatation, rheumatic and IE. Rheumatic valve disease is an important etiology in our SAVR patients especially in mixed aortic valve disease. Study registration IJNREC/562/2022.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Endocardite Bacteriana , Endocardite , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Cardiopatia Reumática , Humanos , Valva Aórtica/cirurgia , Valva Aórtica/patologia , Estudos Retrospectivos , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/etiologia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/patologia , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemodinâmica , Cardiopatia Reumática/complicações , Cardiopatia Reumática/cirurgia , Endocardite/cirurgia , Endocardite/complicações
16.
Anatol J Cardiol ; 28(1): 44-54, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38167795

RESUMO

BACKGROUND: Large-scale multicentric studies reported that, despite advances in diagnosis, antibiotics, and surgical treatment, infective endocarditis (IE) in-hospital mortality remains high. Most data have been obtained from patients treated in infective disease wards, internal medicine, cardiology, or cardiac surgery departments and are therefore heterogeneous. The few studies focused on complicated IE patients leading to intensive care unit (ICU) admission have reported different methodologies and results. The aim of our study was to describe the epidemiological, clinical, and microbial features of critically ill patients admitted to the ICU with a definite IE diagnosis. METHODS: We conducted a prospective case-series population study from January 1, 1998, to December 31, 2020. Patients were divided into 2 groups: 'Ward' (group 1) and 'ICU' patients (group 2), and a 1-year follow-up was performed. RESULTS: After performing a univariate and multivariate logistic regression analysis, we found that the independent predictors of ICU admission were vegetation diameter >10 mm, abnormal PaO2/FiO2 ratio, and acute heart failure. Five independent mortality risk factors were identified: SOFA score >14, not performing surgery, age >70 years, acute heart failure, and embolic complications. CONCLUSIONS: Infective endocarditis in-hospital mortality remains high. ICU admission and mortality can be predicted by independent risk factors.


Assuntos
Endocardite Bacteriana , Endocardite , Insuficiência Cardíaca , Humanos , Idoso , Estudos Retrospectivos , Endocardite Bacteriana/diagnóstico , Endocardite/diagnóstico , Unidades de Terapia Intensiva , Fatores de Risco
17.
Eur J Cardiothorac Surg ; 65(1)2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38175782

RESUMO

OBJECTIVES: This observational study aimed to evaluate Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI) surgery score predictive performance in comparison to general (EuroSCORE I, II) and specific (De Feo, PALSUSE) surgical risk scores for infective endocarditis (IE). METHODS: The study included patients who underwent surgery for IE during the acute phase at Bichat University Hospital (Paris, France) between 1 January 2006 and 31 December 2016 and at Nancy University Hospital (Nancy, France) between 1 January 2009 and 31 December 2019. Patients with IE complicating percutaneous aortic valve implantations or implantable intra-cardiac devices were excluded. Discrimination and calibration were assessed using receiver operating characteristic curve analysis, calibration curves and the Hosmer-Lemeshow test. RESULTS: In-hospital mortality rates were 18% at Bichat and 16% at Nancy. Discrimination was high for all risk scores at Bichat (area under the receiver operating characteristic curve = 0.77 for EuroSCORE I, 0.78 for EuroSCORE II, 0.76 for De Feo score, 0.72 for PALSUSE and 0.73 for AEPEI with 95% confidence interval ranging from 0.67 to 0.83), but lower at Nancy (0.56 for EuroSCORE I, 0.65 for EuroSCORE II, 0.63 for De Feo score, 0.67 for PALSUSE and 0.66 for AEPEI score with 95% confidence interval ranging from 0.47 to 0.75). With Brier score, all scores were adequately calibrated in both populations between 0.129 (De Feo) and 0.135 (PALSUSE) for Bichat and between 0.128 (De Feo) and 0.135 (EuroSCORE I) for Nancy. With the Hosmer-Lemeshow test, the AEPEI score exhibited the best calibration (observed/predicted ratio 1.058 in Bichat, 1.087 in Nancy). CONCLUSIONS: This surgical score external validation in 2 large independent populations demonstrated that the AEPEI surgical score had the best predictive performance compared to other prognosis scores. It could be helpful in clinical practice to assist the endocarditis team in decision-making.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana , Endocardite , Humanos , Medição de Risco , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos Retrospectivos , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Fatores de Risco , Mortalidade Hospitalar
18.
Turk Kardiyol Dern Ars ; 52(1): 36-43, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38221833

RESUMO

OBJECTIVE: Early diagnosis of septic emboli is crucial to prevent the associated morbidity and mortality. This study aimed to examine the relationship between the systemic coagulation inflammation index (SCII) and septic embolism in patients with infective endocarditis (IE). METHODS: We retrospectively analyzed the data of 167 IE patients treated at our tertiary care hospital between January 2007 and January 2023. We collected information on symptoms, comorbidities, predisposing valve diseases, prosthetic valves, devices, history of injectable drug use, blood culture results, echocardiographic findings, and complications. The SCII index was calculated using the formula: [platelet count (PLT) × fibrinogen level (g/L) / white blood cell count (WBC)]. RESULTS: The mean age of the patients was 61 years, with rheumatic valve disease being the most common predisposing factor. The most common etiologic microorganism was Staphylococcus species. Septic embolism developed in 25.7% of the patients, with the cerebral system being the most commonly affected (46.5%). The SCII was identified as an independent marker for the development of septic embolism. Receiver operating characteristic (ROC) curve analysis confirmed that an optimal SCII value of 59.8 predicted septic emboli with a sensitivity of 65.1% and a specificity of 59.6% (area under the ROC curve: 0.649 [95% confidence interval (CI): 0.556 - 0.743], P = 0.004). CONCLUSION: This study demonstrates that high SCII levels are an independent predictor for the development of septic embolism in patients with IE.


Assuntos
Embolia , Endocardite Bacteriana , Endocardite , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Endocardite/complicações , Endocardite/tratamento farmacológico , Endocardite Bacteriana/terapia , Biomarcadores , Inflamação/complicações , Embolia/complicações
19.
Rev Med Suisse ; 20(856-7): 19-24, 2024 Jan 17.
Artigo em Francês | MEDLINE | ID: mdl-38231094

RESUMO

The year 2023 has been extremely rich in new publications in the various subfields of cardiology. Furthermore, the European Society of Cardiology (ESC) has issued revised guidelines focused on the management of acute coronary syndrome (ACS) and endocarditis, as well as an update on the recommendations for the management of heart failure and cardiovascular prevention. The most significant updates according to the Cardiology Department of CHUV are summarized in this review article.


L'année 2023 a été extrêmement riche en nouvelles publications dans les différents sous-domaines de la cardiologie. De plus, la Société européenne de cardiologie (ESC) a formulé des directives révisées axées sur le management du syndrome coronarien aigu (SCA) et de l'endocardite ainsi qu'une mise à jour des recommandations sur la prise en charge de l'insuffisance cardiaque et la prévention cardiovasculaire. Les nouveautés les plus importantes selon l'équipe du Service de cardiologie du CHUV sont résumées dans cet article de synthèse.


Assuntos
Síndrome Coronariana Aguda , Cardiologia , Endocardite , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia
20.
Catheter Cardiovasc Interv ; 103(3): 464-471, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38287781

RESUMO

BACKGROUND: Given the challenges of conventional therapies in managing right-sided infective endocarditis (RSIE), percutaneous mechanical aspiration (PMA) of vegetations has emerged as a novel treatment option. Data on trends, characteristics, and outcomes of PMA, however, have largely been limited to case reports and case series. AIMS: The aim of the current investigation was to provide a descriptive analysis of PMA in the United States and to profile the frequency of PMA with a temporal analysis and the patient cohort. METHODS: The International Classification of Diseases, 10th Revision codes were used to identify patients with RSIE in the national (nationwide) inpatient sample (NIS) database between 2016 and 2020. The clinical characteristics and temporal trends of RSIE hospitalizations in patients who underwent PMA was profiled. RESULTS: An estimated 117,955 RSIE-related hospital admissions in the United States over the 5-year study period were estimated and 1675 of them included PMA. Remarkably, the rate of PMA for RSIE increased 4.7-fold from 2016 (0.56%) to 2020 (2.62%). Patients identified with RSIE who had undergone PMA were young (medial age 36.5 years) and had few comorbid conditions (median Charlson Comorbidity Index, 0.6). Of note, 36.1% of patients had a history of hepatitis C infection, while only 9.9% of patients had a cardiovascular implantable electronic device. Staphylococcus aureus was the predominant (61.8%) pathogen. Concomitant transvenous lead extraction and cardiac valve surgery during the PMA hospitalization were performed in 18.2% and 8.4% of admissions, respectively. The median hospital stay was 19.0 days, with 6.0% in-hospital mortality. CONCLUSIONS: The marked increase in the number of PMA procedures in the United States suggests that this novel treatment option has been embraced as a useful tool in select cases of RSIE. More work is needed to better define indications for the procedure and its efficacy and safety.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Estados Unidos/epidemiologia , Adulto , Pacientes Internados , Sucção , Resultado do Tratamento , Estudos Retrospectivos , Endocardite/diagnóstico , Endocardite/terapia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/terapia
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