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Chen SSY, Lin TTA, Chiang YL, Chen CY, Lin WJ, Chang R. Nontyphoidal salmonellosis is associated with an increased risk of stroke: Insights from multinational real-world data. Int J Stroke 2025; 20:559-571. [PMID: 39749755 DOI: 10.1177/17474930251313717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
BACKGROUND Stroke is a significant cause of morbidity and mortality worldwide, contributing substantially to the global burden of disease. In low- and middle-income countries, stroke tends to occur at younger ages, with infection being one of the notable contributing factors. Previous studies have explored the impact of nontyphoidal Salmonella (NTS) on vascular and blood-related diseases, with animal experiments confirming related mechanisms. This study aims to investigate the association between NTS and cerebrovascular diseases (CVDs), with a focus on identifying specific patient populations more susceptible to stroke due to infection. METHODS This retrospective cohort study utilized the TriNetX database, including 4708 patients infected with NTS compared with a healthy population, with disease risk tracked over 6 months, 1 year, and lifelong periods. The primary outcome was CVDs (ICD-10-CM: I60-I69), while secondary outcomes examined hemorrhagic stroke (ICD-10-CM: I60-I62) and ischemic stroke (ICD-10-CM: I63). Subgroup analyses were conducted based on gender and age at index, with sensitivity analysis performed by comparing hospitalized patients, utilizing different databases, and evaluating the specificity of the NTS-CVD association by examining patients with a higher risk of acute myocardial infarction (AMI). RESULTS The lifelong hazard ratios (HRs) for cerebrovascular diseases (CVD), hemorrhagic stroke, and ischemic stroke following NTS infection were 1.606 (95% confidence interval (CI), 1.410-1.830), 1.866 (95% CI, 1.304-2.669), and 1.717 (95% CI, 1.385-2.130), respectively. A significant increase in the risk of hemorrhagic stroke was observed in the short term and mid-term, with HRs of 3.345 (95% CI, 1.091-10.259) and 2.816 (95% CI, 1.184-6.699), respectively. Subgroup analyses indicated statistically significant associations with the primary outcomes across all age groups. Males demonstrated a higher risk of hemorrhagic stroke, with an HR of 1.891 (95% CI, 1.142-3.310), whereas females exhibited a stronger association with ischemic stroke, with an HR of 1.592 (95% CI, 1.189-2.132). These associations remained significant among hospitalized patients, while no significant relationship was observed between NTS infection and AMI. The findings of this study were reproducible in a US-based database. CONCLUSION There is a significant association between NTS and CVD, with a particularly important impact on the occurrence of stroke in younger populations, especially regarding the elevated risk of hemorrhagic stroke.
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Affiliation(s)
- Sunny Ssu-Yu Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tina Ting-An Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Surgery, Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Lin Chiang
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Yun Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Jen Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Renin Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Recreation and Sports Management, Tajen University, Pintung, Taiwan
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Wang Q, Li JW, Che SZ, Huang JL, Jiang M, Lu JQ, Wu D, Yu DQ, Wei XB. The ratio of blood urea nitrogen to high-density lipoprotein cholesterol: a novel risk-stratifying tool for infective endocarditis. Lipids Health Dis 2025; 24:196. [PMID: 40448042 DOI: 10.1186/s12944-025-02595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Accepted: 05/05/2025] [Indexed: 06/02/2025] Open
Abstract
BACKGROUND Increased blood urea nitrogen (BUN) and decreased high-density lipoprotein cholesterol (HDL) are common in infectious diseases. However, the prognostic significance of the BUN-to-HDL ratio (BHR) in patients with infective endocarditis (IE) is yet unknown. METHODS In all, 1441 patients with confirmed IE were included and divided into four groups according to the level of BUN and HDL: BUN > 5.2mmol/L and HDL < 0.7mmol/L (n = 296), BUN > 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 364), BUN ≤ 5.2mmol/L and HDL < 0.7mmol/L (n = 327), and BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 454). BHR was calculated as BUN/HDL. Multivariable analyses were conducted to determine the association of BHR with adverse events. RESULTS The in-hospital mortality was 6.4%. Patients with BUN > 5.2mmol/L and HDL < 0.7mmol/L had a significantly higher risk of in-hospital death than those with BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (adjusted odds ratio [aOR] = 4.65, 95% confidence interval [CI]: 1.91-11.35, p = 0.001). The decision curve analysis indicated that the combination of BUN and HDL had higher net benefit than either alone. BHR presented a higher predictive value than BUN (AUC: 0.744 vs 0.693, p = 0.01) or HDL (AUC: 0.744 vs 0.648, p < 0.001) for in-hospital mortality, and the optimal cut-off value was 7.4 (sensitivity, 79.3%; specificity, 60.3%). Furthermore, the cumulative 6-month mortality risk was significantly higher in patients with BHR > 7.4 than those with BHR ≤ 7.4 (log-rank = 93.4, p < 0.001). BHR > 7.4 was an independent risk factor for 6-month mortality in IE (adjusted hazard ratio [aHR] = 3.77, 95%CI: 2.32-6.11, p < 0.001). CONCLUSIONS BHR offers a high predictive value for short-term mortality in IE, positioning it as a potential stratification tool for critical care triage.
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Affiliation(s)
- Qi Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Wen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Shuai-Zheng Che
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Mei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jun-Quan Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Di Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Xue-Biao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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Chao P, Zhang X, Zhang L, Ma W, Wang D, Yang A, Chen X. Pan-vaccinomics strategy for developing a universal multi-epitope vaccine against endocarditis-related pathogens. Front Immunol 2025; 16:1524128. [PMID: 40292293 PMCID: PMC12021834 DOI: 10.3389/fimmu.2025.1524128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 03/18/2025] [Indexed: 04/30/2025] Open
Abstract
Introduction Endocarditis is a life-threatening infection of the heart valves, frequently caused by pathogenic bacteria. The growth of multidrug-resistant bacteria necessitates the development of innovative therapeutic techniques, such as vaccines. Methods The current study employed core proteome analysis and a computational-based reverse vaccinology approach across multiple bacterial pathogens associated with endocarditis to identify prospective universal vaccine candidates. The core proteome analysis contained 121 highly pathogenic strains from ten distinct pathogens (Streptococcus mutans, Streptococcus viridans, Streptococcus pyogenes, Staphylococcus aureus, Enterococcus faecalis, Streptococcus agalactiae, Gemella morbillorum, Streptococcus pneumonia, Enterococcus faecium, and Streptococcus gallolyticus). The core proteome was subjected to a subtractive proteomics methodology. Results Three proteins that were virulent, non-homologous, antigenic, and non-allergenic have been identified as prospective candidates for vaccine development: 30S ribosomal protein S13, 50S ribosomal protein L6, and UMP Kinase. B and T cell epitopes were predicted from vaccine candidate proteins using a range of immune-informatics methods. An in silico vaccine was created by using meticulously chosen epitopes-seven Cytotoxic T lymphocyte (CTL), seven Linear B lymphocyte (LBL), and three Helper T lymphocyte (HTL) epitopes-and subsequently aligning them with the major histocompatibility complex (MHC) molecules (MHC I & MHC II) and human TLR4. A Cholera toxin subunit B (CTB) adjuvant was added to the vaccine to enhance the immunological response. The molecular interactions and binding affinity of the vaccine with TLR4 and MHC molecules were analyzed using molecular dynamics (MD) simulations and molecular docking. To ensure optimal vaccine protein expression, the vaccine was cloned and reverse-translated in E. coli. Discussion This methodology tackles the difficulties presented by the diversity of pathogens and antibiotic resistance, providing a strategic option for developing efficient and durable vaccines against infections associated with endocarditis.
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Affiliation(s)
- Peng Chao
- Department of Cardiovascular Disease, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xueqin Zhang
- Department of Nephropathy Disease, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lei Zhang
- Department of Endocrine Disease, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wei Ma
- Department of Electrocardiogram, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Dong Wang
- Department of Electrocardiogram, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Aiping Yang
- Department of Cardiovascular Disease, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xiaoyang Chen
- Department of Cardiovascular Disease, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Luo Y, Yang X, Jiao F, Guo Y, Wang Y. The prognostic role of vegetation size in pediatric infective endocarditis: a retrospective study using decision curve and dose-response analysis. BMC Infect Dis 2025; 25:511. [PMID: 40217174 PMCID: PMC11992701 DOI: 10.1186/s12879-025-10931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 04/07/2025] [Indexed: 04/14/2025] Open
Abstract
OBJECTIVE To explore the predictive value of vegetation size on the prognosis of pediatric infective endocarditis (IE). METHODS A total of 27 children diagnosed with IE who were admitted to Kunming Children's Hospital from January 2014 to June 2024 were included. The good prognosis group comprised 10 cases, while the bad prognosis group comprised 17 cases. The receiver operating characteristic (ROC) curve, restricted cubic spline model, and decision curve analysis were utilized to assess the predictive value of vegetation size on the prognosis of pediatric IE. RESULTS There were statistically significant differences in vegetation size, hemoglobin, platelet count, and prothrombin time between the two groups (P < 0.05). The ROC curve demonstrated that vegetation size had a high predictive accuracy for the prognosis of pediatric IE (AUC = 0.841, 95% CI: 0.775-0.924). Decision curve analysis indicated that vegetation size held substantial clinical value for predicting the prognosis of pediatric IE. The restricted cubic spline analysis revealed a linear dose-response relationship between vegetation size and prognosis of pediatric IE (nonlinear test, P = 0.084). CONCLUSION Significant differences were observed in vegetation size, hemoglobin, platelet count, and prothrombin time between different prognosis of pediatric IE. Limited evidence indicates that vegetation size is a critical factor in predicting the prognosis of pediatric IE. However, studies with larger sample sizes are needed to confirm the accuracy of these conclusions.
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Affiliation(s)
- Yonghan Luo
- Second Department of Infectious Disease, Kunming Children's Hospital, Yunnan key specialty of pediatric infection (training and education program)/Kunming key specialty of pediatric infection, Kunming, 650000, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiaotao Yang
- Second Department of Infectious Disease, Kunming Children's Hospital, Yunnan key specialty of pediatric infection (training and education program)/Kunming key specialty of pediatric infection, Kunming, 650000, Yunnan, China
| | - Feng Jiao
- Second Department of Infectious Disease, Kunming Children's Hospital, Yunnan key specialty of pediatric infection (training and education program)/Kunming key specialty of pediatric infection, Kunming, 650000, Yunnan, China
| | - Yan Guo
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
- Department of Reproductive Gynecology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yanchun Wang
- Second Department of Infectious Disease, Kunming Children's Hospital, Yunnan key specialty of pediatric infection (training and education program)/Kunming key specialty of pediatric infection, Kunming, 650000, Yunnan, China.
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Bartsch B, Ackerschott A, Al Zaidi M, Jamin RN, Nazir MLF, Altrogge M, Fester L, Lambertz J, Coburn M, Nickenig G, Parcina M, Zimmer S, Weisheit CK. A novel approach to studying infective endocarditis: Ultrasound-guided wire injury and bacterial challenge in mice. PLoS One 2025; 20:e0318955. [PMID: 40193365 PMCID: PMC11975138 DOI: 10.1371/journal.pone.0318955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 01/23/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Infective endocarditis (IE) is frequently caused by Staphylococcus aureus (S. aureus) and most commonly affects the aortic valve. Early diagnosis and treatment initiation are challenging because the involved immunological processes are poorly understood due to a lack of suitable in vivo models. OBJECTIVES To establish a novel reproducible murine IE model, based on ultrasound-guided wire injury (WI) induced endothelial damage. METHODS IE was established by inducing endothelial damage via ultrasound-guided wire injury followed by bacterial challenge with S. aureus using 104-6 colony-forming units (CFU) 24h to 72h after wire injury. Cross-sections of valvular leaflets were prepared for scanning electron microscopy (SEM) and immunofluorescence microscopy to visualize valvular invasion of macrophages, neutrophils, and S. aureus. Bacterial cultivation was carried out from blood and valve samples. Systemic immune response was assessed using flow cytometry. RESULTS Wire injury induced endothelial damage was observed in all mice after wire-injury in SEM imaging. We reliably induced IE using 105 (85%) and 106 (91%) CFU S. aureus after wire injury. Aortic regurgitation was more prevalent in wire injury mice after bacterial challenge. Mice undergoing bacterial challenge responded with significant neutrophilia and elevated pro-inflammatory cytokines in the blood. Immunofluorescence staining revealed significantly increased immune cell accumulations using our proposed model compared to controls. CONCLUSION Echocardiography and ex vivo histological staining demonstrated consistent infective endocarditis induction in our new model, combining a wire injury-induced endothelial damage and S. aureus administration. Further exploration of the initial immune cell response and biomarker expression could potentially identify indicators for early IE diagnosis and novel treatment targets.
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Affiliation(s)
- Benedikt Bartsch
- Department of Internal Medicine-II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ansgar Ackerschott
- Department of Internal Medicine-II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Muntadher Al Zaidi
- Department of Internal Medicine-II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Raul Nicolas Jamin
- Department of Internal Medicine-II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Mariam Louis Fathy Nazir
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Moritz Altrogge
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Lars Fester
- Institute of Neuroanatomy of the University of Bonn, University Bonn, Bonn, Germany
| | - Jessica Lambertz
- Institute of Neuroanatomy of the University of Bonn, University Bonn, Bonn, Germany
| | - Mark Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine-II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Marijo Parcina
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine-II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
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Elgharably H, Jenkins H, Cekmecelioglu D, Ayyat KS, Awad AK, Vargo PR, Unai S, Roselli EE, Svensson LG, Pettersson GB. Are early outcomes of reoperative aortic root surgery impacted by previous root procedure and indication for reintervention? JTCVS OPEN 2025; 24:31-46. [PMID: 40309708 PMCID: PMC12039431 DOI: 10.1016/j.xjon.2025.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 01/18/2025] [Accepted: 02/05/2025] [Indexed: 05/02/2025]
Abstract
Objective Reoperative aortic root surgery after a previous root procedure is technically demanding, which can impact outcomes. Herein, we examined the impact of previous root procedure and operative indication on early outcomes. Methods From January 2010 to December 2022, 632 patients underwent reoperative aortic root surgery after previous root procedure (true redo root) at our institution. Baseline characteristics, operative details, and in-hospital complications were compared between groups on the basis of type of previous root prosthesis and infective endocarditis indication. Results In the whole cohort, the operative mortality was 2.2% and estimated survival was 93%, 80%, and 67% at 1, 5, and 10 years, respectively. Operative mortality was similar between previous homograft, Bentall, Freestyle, valve-sparing root reimplantation, and Ross (2%, 4%, 0%, 4%, and 0%, respectively, P = .4). Reoperations after Bentall and valve-sparing root reimplantation (prosthetic grafts) had greater rates of postoperative complications, such as reoperation for bleeding (15% and 8%, P = .01), delayed chest closure (18% and 8%, P = .02), and pacemaker insertion (13% and 12%, P = .03). Although there was no significant difference in operative mortality among patients with endocarditis versus those with other indications (3% vs 1%, P = .08), the postoperative course showed greater rates of reoperation for bleeding (19% vs 5%, P < .01) and prolonged ventilation (38% vs 18%, P < .01). Conclusions At experienced centers, aortic root reoperation (true redo root) can be performed with low operative mortality. Explant of prosthetic graft material and endocarditis are associated with more complicated postoperative course, without significantly increased operative mortality.
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Affiliation(s)
- Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Haley Jenkins
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Davut Cekmecelioglu
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kamal S. Ayyat
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed K. Awad
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Patrick R. Vargo
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eric E. Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Gosta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Held ME, Stambough JB, McConnell ZA, Mears SC, Barnes CL, Stronach BM. Simultaneous Periprosthetic Joint Infection and Infective Endocarditis: Prevalence, Risk Factors, and Clinical Presentation. J Arthroplasty 2025; 40:1021-1027. [PMID: 39341579 DOI: 10.1016/j.arth.2024.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 09/05/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) and periprosthetic joint infections (PJI) occur due to hematogenous bacterial spread, theoretically increasing the risk for concurrent infections. There is a scarcity of literature investigating this specific association. We aimed to assess the prevalence, comorbidities, and clinical presentation of patients who have simultaneous PJI and IE. METHODS We retrospectively identified 655 patients (321 men, 334 women; 382 total hip arthroplasty, 273 total knee arthroplasty) who developed a PJI from July 1, 2015, to December 31, 2020, at one institution. There were two groups created: patients diagnosed with PJI with IE (PJI + IE) and PJI patients who did not have IE (PJI). We analyzed clinical outcomes and comorbidities. RESULTS There were nine patients who had PJI with IE (1.4% of PJI patients). The C-reactive protein (170.9 versus 78, P = 0.026), Elixhauser comorbidity score (P = 0.002), length of hospital stay (10.9 versus 5.7 days, P = 0.043), and the 2-year postdischarge mortality rate (55.6 versus 9.0%, P = 0.0007) were significantly greater in the PJI + IE group. Comorbidities such as iron deficiency anemia (P = 0.03), coagulopathy (P = 0.02), complicated diabetes mellitus (P = 0.02), electrolyte disorders (P = 0.01), neurologic disease (P = 0.004), paralysis (P = 0.04), renal failure (P = 0.0001), and valvular disease (P = 0.0008) occurred more frequently in the PJI + IE group. Modified Duke's criteria were met for possible or definite IE in eight of the nine patients. CONCLUSIONS Concurrent PJIs and IE, although rare, are a potentially devastating disease state with increased length of hospital stay and 2-year mortality rates. This emphasizes the need for appropriate IE workups in patients who have a PJI. The modified Duke's criteria are effective in establishing a diagnosis for IE in this scenario.
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Affiliation(s)
- Michael E Held
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jeffery B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Zachary A McConnell
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Florida, Gainesville, Florida
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Liu RL, Ou YP, Zhang Q, Yang YF. Mendelian Randomization Reveals No Causal Association Between Periodontitis and Infective Endocarditis. Int Dent J 2025; 75:832-839. [PMID: 39097439 PMCID: PMC11976596 DOI: 10.1016/j.identj.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVES Clarifying the uncertain causal relationship between periodontitis and infective endocarditis using Mendelian randomization analysis, given their historically perceived association and clinical significance. METHODS Genetic variation data for acute periodontitis, chronic periodontitis, aggressive periodontitis, and infective endocarditis were obtained from published GWAS in individuals of European ancestry. Instrumental variables significantly associated with periodontitis were selected and univariable Mendelian randomization was conducted to infer the causal association between periodontitis and infective endocarditis. Multivariable Mendelian randomization was also performed to adjust for potential confounders including smoking, drinking, diabetes, and education. RESULTS Our analysis found no evidence of a causal association between periodontitis and infective endocarditis, with odds ratios (ORs) of 0.992 (95% CI: 0.879-1.120), 0.947 (95% CI: 0.738-1.214), and 1.056 (95% CI: 0.916-1.217) for acute periodontitis, chronic periodontitis, aggressive periodontitis, respectively. The robustness of our findings was confirmed by heterogeneity tests, pleiotropy tests, leave-one-out analyses, and MR-PRESSO. In the multivariable MR analysis, adjusting for smoking, drinking, diabetes, and education, the overall patterns between genetic liability to periodontitis and infective endocarditis remained consistent (all P > .05). CONCLUSION Our findings indicate that there is no genetic causal association between periodontitis and infective endocarditis.
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Affiliation(s)
- Rui-Lin Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Yu-Ping Ou
- Department of Ultrasound, Chen Zhou No. 1 People's Hospital, ChenZhou, China
| | - Qian Zhang
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Yi-Feng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China.
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Wu Z, Chen Y, Ma Y, Xiao T, Xiao Y. Economic burden of infective endocarditis in Zhejiang region from 2007 to 2016. BMC Infect Dis 2025; 25:455. [PMID: 40169965 PMCID: PMC11963642 DOI: 10.1186/s12879-025-10846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 03/21/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Infective endocarditis (IE) has attracted widespread public attention. However, studies on its economic burden remain scarce. METHODS This retrospective study aimed to collect data on the clinical characteristics of patients with IE from electronic medical records and estimate the economic burden with disability-adjusted life years (DALYs). Additionally, the changing trend of IE from 2007 to 2016 and differences between native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) on economic burden were analyzed. RESULTS There were 407 patients with IE enrolled in this study. The total DALY loss was 1710.2. The average indirect economic burden ranged from $6253.27 to $14766.34 from 2007 to 2016 showing a stable trend, which was 1.67 to 2.46 times the annual per gross domestic product (GDP). Interestingly, the average indirect economic burden for females ranged from $5941.37 to $17261.07 with a significant upward trend during this period (P = 0.035).The average DALY loss and indirect economic burden were highest in patient aged ≤ 19 (4.82, $21486.12) and lowest in those aged 80-89(0.46, $342.87), decreasing significantly with age(both P<0.001). Finally, there were no significant differences in the average DALY loss and indirect economic burden between the PVE group and NVE group during this period (2.69 vs. 2.63, P = 0.740; $9224.0vs. $11789.4, P = 0.136). CONCLUSIONS The DALY loss and indirect economic burden associated with IE were notably high, particularly among younger patients and females. These findings highlight the need for targeted preventive care and early interventions, especially for youth and gender-specific strategies, to reduce disparities in IE burden.
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Affiliation(s)
- Zhenzhu Wu
- Department of Infectious Disease, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325025, China
| | - Yi Chen
- Department of Gastroenterology, Wenzhou People's Hospital, Wenzhou, 325000, China
| | - Yingying Ma
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Tingting Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China.
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10
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Demal TJ, Arndt N, Bhadra OD, Ludwig S, Grundmann D, Voigtlaender-Buschmann L, Waldschmidt L, Hannen L, Blankenberg S, Kirchhof P, Conradi L, Reichenspurner H, Schofer N, Schaefer A. Predictors for Length of Stay after Surgical Aortic Valve Replacement. Thorac Cardiovasc Surg 2025. [PMID: 39537128 DOI: 10.1055/a-2466-7245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
OBJECTIVES Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement. METHODS Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed. RESULTS Upon multivariable linear regression, endocarditis (regression coefficient [β] 2.98; 95% confidence interval [CI] 1.51, 4.45; p < 0.001]) and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p = 0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p = 0.001) as well as chronic obstructive pulmonary disease (COPD) (β 1.61; 95% CI 0.66, 2.55; p = 0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p = 0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p = 0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p = 0.006). CONCLUSION Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and COPD. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.
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Affiliation(s)
- Till Joscha Demal
- Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Nico Arndt
- Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Lisa Voigtlaender-Buschmann
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Laura Hannen
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Hamburg, Germany
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11
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Huang JB, Lu CC, Wen ZK. Surgical treatment for infectious endocarditis in China. Medicine (Baltimore) 2025; 104:e41882. [PMID: 40101053 PMCID: PMC11922448 DOI: 10.1097/md.0000000000041882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 02/27/2025] [Indexed: 03/20/2025] Open
Abstract
This important topic of infectious endocarditis (IE) has been covered previously with large multicenter studies and reviews of national databases, most of which come from developed countries. While studies on IE in developing countries such as China are rare, a study of IE undergoing cardiac surgery in China was conducted to investigate retrospective risk factors for hospital mortality of cardiac surgery for IE. This study of patients with IE receiving cardiac surgery in the research period at our medical center was performed retrospectively; 896 patients were assigned to the hospital mortality group (n = 48) and none hospital mortality group (n = 848). Forty-eight operative deaths (5.4%) occurred. Binary logistic regression analysis for independent risk factors for hospital mortality indicated that neurological complications preoperative, destructive annulus, preoperative mitral insufficiency, postoperative left ventricular ejection fractions, and paravalvular leak are related to hospital mortality (all P < .001). We identified modifiable risk factors for hospital mortality of cardiac surgery for IE. Early and timely diagnosis and surgery, advancement of surgical techniques, and excellent cardiac protection may decrease hospital mortality for IE.
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Affiliation(s)
- Jing-Bin Huang
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Chang-Chao Lu
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
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12
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Kim M, Damronglerd P, Molina Garcia S, Yetmar ZA, Razi S, Ranganath N, Mahmood M, Abu Saleh OM. Illuminating the Challenges and Diagnostic Utility of Plasma Microbial Cell-Free DNA Sequencing in Suspected Infective Endocarditis: A Retrospective Observational Cohort Study. Open Forum Infect Dis 2025; 12:ofaf099. [PMID: 40046887 PMCID: PMC11879537 DOI: 10.1093/ofid/ofaf099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 02/13/2025] [Indexed: 03/09/2025] Open
Abstract
Background Infective endocarditis (IE) is a life-threatening infection often challenging to diagnose, particularly in culture-negative cases. Plasma microbial cell-free DNA (mcfDNA) sequencing has shown potential for detecting pathogens in IE. However, its clinical utility, diagnostic impact, and limitations remain debated. This study evaluates its use in diagnosing and managing IE in a tertiary care setting. Methods This single-center retrospective cohort study included adult patients (≥18 years) who underwent mcfDNA sequencing via the Karius test for suspected IE at Mayo Clinic Rochester between December 2019 and February 2024. Diagnostic classification followed the 2023 Duke-International Society of Cardiovascular Infectious Diseases criteria. Data on demographics, clinical features, routine microbiologic workup, and mcfDNA sequencing results were collected. Statistical analysis was conducted to evaluate diagnostic utility and treatment impact. Results Among 141 patients, 66 had a diagnosis of IE, with mcfDNA sequencing identifying pathogens in 60.6% of them, compared with 39.4% with routine workup. mcfDNA sequencing was the sole microbiologic test with positive results in 33.3% of patients, leading to antimicrobial adjustments in 50.0% of that group. Clinically insignificant mcfDNA sequence detection occurred in 28.6% of patients without a diagnosis of IE. Conclusions mcfDNA sequencing is a valuable adjunctive tool for diagnosing culture-negative IE and guiding antimicrobial therapy when clinical suspicion is high. However, its utility depends on appropriate clinical context, highlighting the need for careful test interpretation and further prospective studies to assess patient-centered outcomes and cost-effectiveness.
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Affiliation(s)
- Myeongji Kim
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pansachee Damronglerd
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Sofia Molina Garcia
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Zachary A Yetmar
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samrah Razi
- Department of Internal Medicine, Washington University, St. Louis, Missouri, USA
| | - Nischal Ranganath
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Stoican IC, Dragoș D, Papagheorghe A, Guberna SM, Tuta S, Manea MM. Silent strike: stroke in context of endocarditis - brain imaging as a catalyst for diagnosis. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2025:rjim-2025-0003. [PMID: 40019205 DOI: 10.2478/rjim-2025-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Indexed: 03/01/2025]
Abstract
INTRODUCTION Endocarditis is a pathology which is rarely encountered in clinical practice that presents itself in various manners, thus posing a great challenge for the clinician in the process of formulating a timely diagnosis, especially given its potentially lethal evolution. The diagnosis of infective endocarditis is based on Modified Duke Criteria. A wide array of complications may accompany endocarditis, including septic or thrombotic emboli to various territories - those occluding branches of cerebral arteries result in ischemic strokes, which may be demonstrated by brain imaging and the symptoms which may range from mild mental status alteration to deep coma. Objective: Assessment of brain imaging as a diagnostic tool for bacterial endocarditis. MATERIALS AND METHODS This is a nested case-control study, in which 84 patients with ischemic stroke were enrolled, half of them having endocarditis related stroke (cases), and the other half stroke due to cardioembolism from other sources or to large-artery atherosclerosis (controls). RESULTS Brain imaging revealed statistically significant differences between the two cohorts, endocarditis related stroke being more strongly associated with multiple territories involvement, multiple lesions coexistence, watershed lesions, and a greater extent of ischemia all these may serve as valuable diagnostic clues. Among these findings, the presence of multiple lesions has been the most sensitive tool (Sn = 0.786, Sp = 0.857, LR+ = 5.497, LR- = 0.25), while the involvement of multiple arterial territories had the highest specificity and positive likelihood ratio for endocarditis-related stroke (Sn = 0.738, Sp = 0.929, LR+ = 10.394, LR- = 0.282). A larger ischemic lesion as quantified by pc-ASPECTS score (more than by the ASPECTS score) also increases the likelihood of endocarditis as the cause of ischemic stroke, with an AUROC of 0.7361 (95% CI 0.629-0.843). CONCLUSIONS Early brain imaging could play a crucial role in endocarditis, helping the clinician to suspect this diagnosis. Further studies are needed to understand the role of early brain imaging when Modified Duke Criteria fail to establish the diagnosis.
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Affiliation(s)
- Iulia-Cosmina Stoican
- Neurology Department, National Institute of Neurology and Neurovascular Diseases, Bucharest, Romania
| | - Dorin Dragoș
- Internal Medicine Department, University Emergency Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Atena Papagheorghe
- Neurosurgery Department, University Emergency Hospital, Bucharest, Romania
| | - Suzana Maria Guberna
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Cardiology Department, Emergency Clinical Hospital Prof. Dr. Bagdasar-Arseni, Bucharest, Romania
| | - Sorin Tuta
- Neurology Department, National Institute of Neurology and Neurovascular Diseases, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Mirabela Manea
- Neurology Department, National Institute of Neurology and Neurovascular Diseases, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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14
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Jamil H, Ezzo T, Doumi A, Diab ZAE, Saleem A. A Case Report of Neisseria sicca Endocarditis in a Patient with Tissue Aortic Valve: Favorable Outcome Following Prompt Multidisciplinary Team Management. Br J Hosp Med (Lond) 2025; 86:1-6. [PMID: 39998144 DOI: 10.12968/hmed.2024.0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
Neisseria sicca is commonly found in oral flora and is usually deemed harmless. Neisseria sicca is very rarely associated with infective endocarditis and has a high mortality rate with it. We present a case of infective endocarditis in a 57-year-old male who presented with fever, lethargy, and reduced mobility and was admitted to an acute medical unit of a UK district general hospital. Serial blood cultures grew Neisseria sicca and transoesophageal echocardiography confirmed vegetation on the aortic valve. As per microbiology advice, his antibiotic treatment was adjusted to oral ciprofloxacin and intravenous ceftriaxone for 6 weeks given this organism's sensitivity. The cardiology team arranged outpatient appointments for long-term follow-ups. Involving acute medicine, microbiology, and cardiology teams as part of a multidisciplinary team (MDT) led to good clinical outcomes and patients remained alive and well on follow-ups. So far only 27 cases have been documented and we think our work would increase insights into management strategies for this condition particularly the utilization of the MDT approach.
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Affiliation(s)
- Husam Jamil
- Acute Medicine, Yorkshire and Humber Deanery, Leeds, UK
| | - Talal Ezzo
- Cardiology, Calderdale and Huddersfield Foundation Trust, Halifax, UK
| | - Aymen Doumi
- Acute Medicine, Yorkshire and Humber Deanery, Hull, UK
| | | | - Anum Saleem
- Microbiology, Calderdale and Huddersfield Foundation Trust, Halifax, UK
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15
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Hallinen KM, Bodine SP, Stone HA, Muir TW, Wingreen NS, Gitai Z. Bacterial species with different nanocolony morphologies have distinct flow-dependent colonization behaviors. Proc Natl Acad Sci U S A 2025; 122:e2419899122. [PMID: 39928871 PMCID: PMC11848407 DOI: 10.1073/pnas.2419899122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 11/25/2024] [Indexed: 02/12/2025] Open
Abstract
Fluid flows are dominant features of many bacterial environments, and flow can often impact bacterial behaviors in unexpected ways. For example, the most common type of cardiovascular infection is heart valve colonization by gram-positive bacteria like Staphylococcus aureus and Enterococcus faecalis (endocarditis). This behavior is counterintuitive because heart valves experience high shear rates that would naively be expected to reduce colonization. To determine whether these bacteria preferentially colonize higher shear rate environments, we developed a microfluidic system to quantify the effect of flow conditions on the colonization of S. aureus and E. faecalis. We find that the preferential colonization in high flow of both species is not specific to heart valves and can be found in simple configurations lacking any host factors. This behavior enables bacteria that are outcompeted in low flow to dominate in high flow. Surprisingly, experimental and computational studies reveal that the two species achieve this behavior via distinct mechanisms. S. aureus grows in cell clusters and produces a dispersal signal whose transport is affected by shear rate. Meanwhile, E. faecalis grows in linear chains whose mechanical properties result in less dispersal in the presence of higher shear force. In addition to establishing two divergent mechanisms by which these bacteria each preferentially colonize high-flow environments, our findings highlight the importance of understanding bacterial behaviors at the level of collective interactions among cells. These results suggest that distinct multicellular nanocolony morphologies have previously unappreciated costs and benefits in different environments, like those introduced by fluid flow.
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Affiliation(s)
| | - Steven P. Bodine
- Department of Chemistry, Princeton University, Princeton, NJ08544
| | - Howard A. Stone
- Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ08544
| | - Tom W. Muir
- Department of Chemistry, Princeton University, Princeton, NJ08544
| | - Ned S. Wingreen
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ08544
- Department of Molecular Biology, Princeton University, Princeton, NJ08544
| | - Zemer Gitai
- Department of Molecular Biology, Princeton University, Princeton, NJ08544
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16
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Andreß S, Reischmann K, Markovic S, Rohlmann F, Hay B, Rottbauer W, Buckert D, d'Almeida S. Men's more frequent predisposing factors in infectious endocarditis facilitate improvement of outcomes by shortening of diagnostic delay. Front Cardiovasc Med 2025; 11:1517288. [PMID: 40012848 PMCID: PMC11860880 DOI: 10.3389/fcvm.2024.1517288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 12/27/2024] [Indexed: 02/28/2025] Open
Abstract
Introduction Despite growing evidence for sex-specific differences in cardiovascular disease, sex is poorly considered in the management of infectious endocarditis (IE). Purpose This study aimed to assess sex-specific aspects in diagnosing IE. Methods All consecutive patients admitted at Ulm University Heart Center with suspected IE between 2009 and 2019 were included. IE was diagnosed using the Duke criteria. Risk factors, clinical presentation and in-hospital outcomes along with the impact of diagnostic delay were compared between male and female patients. Results IE was diagnosed in 96 of 118 men (81.4%) and 33 of 45 women (73.3%) (p = 0.121). Time to diagnosis was similar between the groups (p = 0.598). Regarding patient characteristics, men were younger (65.5 vs. 74.3 years, p = 0.006). Men exhibited a higher prevalence of predisposing cardiac conditions (p = 0.012) due to a higher frequency of a history of implantable cardioverter defibrillator implantation (p = 0.004), and were more likely to have poor dental status (p = 0.001), and coronary artery disease (p = 0.002). The incidence of the complications of heart failure with reduced ejection fraction (p = 0.007) and new-onset dialysis (p = 0.012) were higher, the time in the intensive care unit (p = 0.012) longer. Male sex was the only independent risk factor for in-hospital mortality [p = 0.036, HR 4.127 (95%-CI 1.096-15.538)]. Notably, only in the male cohort, a shorter time to diagnosis was associated with a lower mortality rate (p = 0.035, optimal cut-point 3.5 days). Men diagnosed within 3.5 days had a mortality rate of 13.5% compared to 31.8% for those diagnosed later (p = 0.028). Conclusion Men with suspected IE are younger, have more predisposing factors and experience a more complicated course of disease, while benefiting from early diagnosis. Therefore, recognizing the heightened risk profile specific to men during diagnosis can help to address their poorer prognosis.
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Affiliation(s)
- S. Andreß
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - K. Reischmann
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - S. Markovic
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - F. Rohlmann
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - B. Hay
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - W. Rottbauer
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - D. Buckert
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - S. d'Almeida
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
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17
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Costeira R, Macedo Brás E, Manuel Pereira R, Barbosa Leão I, Canelas C. A Case of Complicated Bacteremia: When the Source Is in the Blood. Cureus 2025; 17:e79782. [PMID: 40028431 PMCID: PMC11870769 DOI: 10.7759/cureus.79782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2025] [Indexed: 03/05/2025] Open
Abstract
Infective endocarditis is an infectious disease of the heart tissue, mainly affecting heart valves and intracardiac devices. We present the case of a 71-year-old male pacemaker carrier with a history of hepatic cirrhosis, esophageal varices, hepatocellular carcinoma, and severe aortic stenosis, who was admitted to the emergency room and hospitalized due to upper gastrointestinal bleeding. Although upper endoscopy showed no signs of active acute hemorrhage, the patient required a red blood cell transfusion. Upon admission, elevated inflammatory parameters prompted the initiation of empirical therapy with ceftriaxone. Although urinalysis, chest X-ray, thoracoabdominopelvic computed tomography, and transthoracic echocardiogram weren't suggestive of infection, an Enterococcus faecium was isolated in blood cultures. Following an antibiotic switch to daptomycin, based on susceptibility testing, and the patient's hemodynamic stability, he was transferred to a home hospitalization unit for continued care. Despite good clinical and analytical progress, the patient's history of aortic valve stenosis and pacemaker, along with persistently positive blood cultures despite antibiotic therapy and sustained fever, raised a high level of clinical suspicion. This led to the decision to perform a new echocardiogram, which revealed several aortic valve vegetations, allowing the diagnosis of infective endocarditis. Following a multidisciplinary discussion, and in accordance with antibiotic susceptibility tests, linezolid was initiated. After 40 days, although the echocardiogram was still suggestive of aortic valve infiltration due to an infectious process, hemodynamic stability, sustained apyrexia, and sterile blood cultures allowed for a possible discharge on oral therapy with moxifloxacin and rifampicin. Although this is a case of infective endocarditis in a high-risk patient, the chronology is unusual, as endocarditis was not detected in the initial echocardiogram. The diagnosis was only possible after weeks of persistent positive blood cultures, thanks to the medical team's high level of suspicion, which led them to insist on repeating the echocardiogram. In fact, the diagnosis of infective endocarditis remains a challenge to this day. This case highlights the importance of recognizing risk factors and pursuing the diagnosis when clinical suspicion persists, including repeating imaging when necessary to ensure timely diagnosis and appropriate management.
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Affiliation(s)
- Raquel Costeira
- Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Elisa Macedo Brás
- Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Ricardo Manuel Pereira
- Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Inês Barbosa Leão
- Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Catia Canelas
- Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT
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18
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Lnu S, Jamal A, Raza MA, Umar Z, Ahmad S, Alvi W, Khattak LZ, Ajmal A, Ullah N, Khan K. Infective Endocarditis in Septic Shock: Results From an Observational Multicenter Study. Cureus 2025; 17:e78927. [PMID: 40092000 PMCID: PMC11909614 DOI: 10.7759/cureus.78927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2025] [Indexed: 03/19/2025] Open
Abstract
Introduction Infective endocarditis (IE) in patients with septic shock poses diagnostic challenges due to overlapping systemic effects and comorbidities, making early recognition crucial for improving outcomes. This study aimed to characterize the clinical features, diagnostic findings, and outcomes of IE in septic shock to inform better early recognition and management strategies in emergency and critical care settings. Methodology A multicenter observational study was conducted across three tertiary care hospitals in Pakistan over two years, involving 300 patients presenting with septic shock and confirmed IE. Adults aged 18 years or older who met the Sepsis-3 criteria and were diagnosed with IE using the modified Duke criteria were included. Data collected included demographics, clinical characteristics, imaging results, blood cultures, inflammatory markers, treatment plans, and outcomes (e.g., mortality, embolic events, ICU admission). Multivariate analysis identified independent predictors of adverse outcomes, adjusting for confounders such as age and comorbidities. Missing data were addressed using multiple imputations, which allows for the creation of several plausible datasets to account for uncertainty and minimize bias. This method was selected over simpler approaches, such as mean or median imputation, to enhance the robustness of our findings. Results The mean age was 55.20 ± 14.70 years, the incidence of echocardiographic positivity was 96.33% (n=289), and blood culture positivity was 92.67% (n=278). At admission, patients exhibited varying degrees of septic shock severity based on hemodynamic instability, with hypotension (83.33%) being a prominent feature. Fever (90%) and dyspnea (60%) were among the most frequently reported symptoms. Diagnostic challenges were encountered in 12% of cases, where initial differential diagnoses excluded IE but were later revised based on echocardiographic and microbiological confirmation. Pathogens predominantly included Staphylococcus aureus (50%) and Streptococcus species (30%), with polymicrobial infections noted in 8% of cases. Complications included embolic events (33%), heart failure (28%), renal dysfunction (25%), and neurological involvement such as stroke (10%). ICU admission was required in 50% (n=150) of cases, and in-hospital mortality occurred in 17% (n=51). Predictors of adverse outcomes included older age (AOR: 1.05, 95% CI: 1.02-1.08, p=0.001), prior cardiovascular disease (AOR: 2.14, 95% CI: 1.12-4.08, p=0.021), echocardiographic positivity (AOR: 2.43, 95% CI: 1.36-4.34, p<0.001), blood culture positivity (AOR: 2.50, 95% CI: 1.43-4.34, p<0.001), embolic events (AOR: 3.10, 95% CI: 1.86-5.14, p<0.001), and elevated inflammatory markers (AOR: 2.34, 95% CI: 1.43-3.83, p<0.001). Conclusion This study reveals that early identification of IE in patients with septic shock is essential for improving outcomes. Key findings include the high diagnostic value of echocardiography and blood cultures in confirming IE, with prior cardiovascular disease emerging as a significant predictor of adverse outcomes. Embolic events and elevated inflammatory markers also played critical roles in predicting patient prognosis. A focused approach to early diagnosis, particularly through these key diagnostic tools, is crucial for timely intervention. Prioritizing these factors in clinical practice can help improve patient outcomes, especially in emergency and resource-limited settings.
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Affiliation(s)
- Saad Lnu
- General Medicine, Lady Reading Hospital Medical Teaching Institution, Peshawar, PAK
| | - Asif Jamal
- Internal Medicine, Bukhari Medical and Surgical Complex, Bannu, PAK
| | - Muhammad A Raza
- Cardiology, Sardar Fateh Muhammad Khan Buzdar Institute Of Cardiology, Dera Ghazi Khan, PAK
| | - Zeeshan Umar
- Emergency Medicine, Pak Emirates Military Hospital, Rawalpindi, PAK
| | - Sohail Ahmad
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Wafa Alvi
- Emergency Medicine, POF Hospital Wah Cantt, Wah Cantt, PAK
| | | | - Aamir Ajmal
- Neurology, Rehman Medical Institute, Peshawar, PAK
- Internal Medicine, Bukhari Medical and Surgical Complex, Bannu, PAK
| | - Naqeeb Ullah
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Kainat Khan
- Resident Physician, Lady Reading Hospital, Peshawar, PAK
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19
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Sinitskaya A, Kostyunin A, Asanov M, Khutornaya M, Klyueva A, Poddubnyak A, Tupikin A, Kabilov M, Sinitsky M. Bacterial Diversity in Native Heart Valves in Infective Endocarditis. Biomedicines 2025; 13:245. [PMID: 39857828 PMCID: PMC11762347 DOI: 10.3390/biomedicines13010245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/14/2025] [Accepted: 01/18/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Infective endocarditis (IE) is an infectious disease caused by the hematogenous dissemination of bacteria into heart valves. Improving the identification of pathogens that cause IE is important to increase the effectiveness of its therapy and reduce the mortality caused by this pathology. Methods: Ten native heart valves obtained from IE patients undergoing heart valve replacements were analyzed. Bacterial invasion in the heart valves was studied by Gram staining of histological sections. Histopathological changes accompanied with bacterial invasion were studied by immunohistochemical analysis of pan-leukocyte marker CD45, platelet marker CD41, and neutrophil myeloperoxidase. The taxonomic diversity of the bacteria was analyzed using 16S rRNA metabarcoding. Results: Gram staining of the histological sections revealed bacterial cells localized on the atrial surface at the leaflet's free edge or on the ventricular surface at the leaflet's base within fibrin deposits in only three of the studied heart valves. Bacterial colonies were co-localized with microthrombi (CD41+ cells) containing single leucocytes (CD45+ cells), represented by segmented neutrophils. As a result of 16S rRNA metabarcoding, we detected the following bacterial genera: Pseudomonas (70% of the studied heart valves), Roseateles (60%), Acinetobacter (40%), Sphingomonas (40%), Enterococcus (30%), Reyranella (20%), Sphingobium (20%), Streptococcus (20%), Agrobacterium (20%), Ralstonia (10%), and Bacillus (10%). Conclusions: A number of opportunistic microorganisms that could not be detected by routine laboratory tests and were not eliminated during antibiotic therapy were identified in the IE-affected heart valves. The obtained results show the importance of 16S rRNA metabarcoding of heart valves removed due to IE not only as an independent diagnostic method but also as a highly accurate approach that complements routine tests for pathogen identification.
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Affiliation(s)
- Anna Sinitskaya
- Laboratory of Genome Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Alexander Kostyunin
- Laboratory of Novel Biomaterials, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Maxim Asanov
- Laboratory of Genome Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Maria Khutornaya
- Laboratory of Genome Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Anastasia Klyueva
- Laboratory of Genome Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Alyona Poddubnyak
- Laboratory of Genome Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Alexey Tupikin
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Marsel Kabilov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Maxim Sinitsky
- Laboratory of Genome Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
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20
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Hopf AGM, Kursawe L, Schubert S, Moter I, Wiessner A, Sarbandi K, Eszlari E, Cvorak A, von Schöning D, Klefisch FR, Moter A, Eichinger W, Kikhney J. Diagnostic Impact of FISHseq as a New Pathologic Criterion for Endocarditis According to the Duke Criteria. Open Forum Infect Dis 2025; 12:ofae716. [PMID: 39758740 PMCID: PMC11697105 DOI: 10.1093/ofid/ofae716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/09/2024] [Indexed: 01/07/2025] Open
Abstract
Background For clinicians treating patients with infective endocarditis (IE), identifying the causative microorganisms poses a critical diagnostic challenge. Standard techniques including blood and heart valve cultures often yield inconclusive results. According to the recent 2023 Duke-ISCVID Criteria, molecular methods represent potent tools to enhance this aspect of IE diagnostics and guide subsequent therapeutic strategies. Methods We retrospectively analyzed data from 124 consecutive patients who underwent heart valve surgery due to suspected IE at München Klinik Bogenhausen. The standard diagnostic pathway, which included blood culture, valve culture, histopathological analysis, and polymerase chain reaction (PCR)/sequencing, was compared with the enhanced diagnostic pathway, which included fluorescence in situ hybridization + PCR/sequencing (FISHseq) instead of PCR/sequencing alone. The aim of this study was to assess the added value of combining standard diagnostics with molecular methods such as PCR/sequencing or FISHseq for the diagnosis of IE and the potential impact on therapy. Results Standard diagnostic methods and PCR/sequencing yielded inconclusive results in 57/124 cases (46.0%). FISHseq provided an added value for diagnostics in 79/124 cases (63.7%) and potentially would have impacted therapy in 95/124 (76.6%) of cases. By adding data through direct visualization and characterization of microorganisms, FISHseq reduced the number of inconclusive cases by 86.0%. Conclusions The comparison of 2 molecular diagnostic tools for IE from the same heart valve emphasizes the value of molecular methods including molecular imaging by FISH for IE diagnostics and supports the 2023 Duke-ISCVID Criteria.
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Affiliation(s)
- Alexander G M Hopf
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Laura Kursawe
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Sören Schubert
- Max von Pettenkofer Institute for Hygiene and Medical Microbiology of the Ludwig-Maximilians–Universität München, Munich, Germany
| | - Isabell Moter
- Department of Cardiac Surgery, München Klinik Bogenhausen, Munich, Germany
| | - Alexandra Wiessner
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
| | - Kurosh Sarbandi
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Edgar Eszlari
- Department of Cardiac Surgery, München Klinik Bogenhausen, Munich, Germany
| | - Adi Cvorak
- Department of Cardiac Surgery, München Klinik Bogenhausen, Munich, Germany
| | | | | | - Annette Moter
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
- Moter Diagnostics, Berlin, Germany
| | - Walter Eichinger
- Department of Cardiac Surgery, München Klinik Bogenhausen, Munich, Germany
| | - Judith Kikhney
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
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21
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Vinod P, Khayata M, Haouzi A, Xu B. Role of multimodality imaging in infective endocarditis: A comparison of the major society guidelines in the United States and Europe. Trends Cardiovasc Med 2025; 35:10-21. [PMID: 38677351 DOI: 10.1016/j.tcm.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
Infective endocarditis (IE) is a life-threatening condition, and early diagnosis and management are critical. There is emerging evidence on the role of advanced imaging modalities including dedicated cardiac computed tomography (CCT), and 18F-fluorodeoxyglucose positron emission tomography (PET). The updated 2023 European Society of Cardiology (ESC) guidelines have emphasized increased utilization of multimodality imaging in the diagnosis and management of IE. In this review, we elaborate on recent recommendations from the updated 2023 ESC guidelines, with comparisons to the current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, focusing on multimodality imaging in IE.
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Affiliation(s)
- Poornima Vinod
- UNC Health at Southeastern, Department of Internal Medicine, Lumberton, NC 28358, USA
| | - Mohamed Khayata
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Alice Haouzi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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22
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Owlia M, Hsi DH. Editorial commentary: Infective endocarditis: Harnessing the power of advanced imaging. Trends Cardiovasc Med 2025; 35:22-23. [PMID: 38839436 DOI: 10.1016/j.tcm.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Mina Owlia
- Director of Cardio-Oncology, Stamford Hospital, CT 06902, Clinical Assistant Professor, Colombia University Vagelos College of Physicians and Surgeons, NY, USA
| | - David H Hsi
- Chief of Cardiology & Co-Director, Heart & Vascular Institute, Stamford Hospital, CT 06902, Professor of Clinical Medicine, Columbia University Vagelos College of Physicians & Surgeons, NY, USA.
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23
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Holcman K, Ząbek A, Boczar K, Rubiś P, Ćmiel B, Szot W, Stępień A, Graczyk K, Podolec P, Kostkiewicz M. The [ 99mTc]Tc-HMPAO-labelled white blood cell SPECT/CT as a novel criterion for infective endocarditis diagnosis. Int J Cardiol 2024; 417:132545. [PMID: 39265788 DOI: 10.1016/j.ijcard.2024.132545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/11/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
AIMS Infective endocarditis (IE) poses a significant clinical challenge, necessitating nuanced diagnostic tools for early and accurate detection. The diagnostic role of the hybrid technique of single-photon emission tomography-computed tomography with technetium-99 m-hexamethylpropyleneamine oxime-labelled leukocytes ([99mTc]Tc-HMPAO-SPECT/CT) has evolved in recent years. This single-center study assessed whether the recent inclusion in the 2023 European Society of Cardiology modified diagnostic criteria of IE (2023 ESC) of infectious lesions detected with [99mTc]Tc-HMPAO-SPECT/CT affects their diagnostic performance. METHODS AND RESULTS Between 2015 and 2019, we enrolled 205 consecutive adults with suspected IE. All participants underwent [99mTc]Tc-HMPAO-SPECT/CT scans (370-740 MBq). Scans were deemed positive in the presence of intracardiac abnormal tracer uptake and/or within the cardiac implantable electronic device. Patients were prospectively followed-up for 12 ± 10 months. Local device infection (LDI) or IE was diagnosed in 75 (36.6 %) patients, while 72 (35.1 %) [99mTc]Tc-HMPAO-SPECT/CT results returned positive. Moreover, extracardiac infectious foci were detected in 25 % of [99mTc]Tc-HMPAO-SPECT/CT scans. The inclusion of both intracardiac and extracardiac lesions detected with [99mTc]Tc-HMPAO-SPECT/CT yields significantly higher sensitivity (p = 0.003) and negative predictive value (NPV) (p = 0.009). CONCLUSION The inclusion of [99mTc]Tc-HMPAO-SPECT/CT into the IE diagnostic work-up improves the appropriate classification of patients. For patients with IE, the extended inclusion of lesions detected with [99mTc]Tc-HMPAO-SPECT/CT in the ESC 2023 diagnostic criteria significantly improves sensitivity and NPV while reducing potential IE misdiagnoses. This pioneering imaging modality is poised to become an integral component of clinical practice, promising to advance IE diagnosis and management.
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Affiliation(s)
- Katarzyna Holcman
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland.
| | - Andrzej Ząbek
- Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Boczar
- Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland
| | - Paweł Rubiś
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Bogdan Ćmiel
- AGH University of Science and Technology, Faculty of Applied Mathematics, Krakow, Poland
| | - Wojciech Szot
- John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland; Jagiellonian University Medical College, Department of Hygiene and Dietetics, Krakow, Poland
| | - Agnieszka Stępień
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Katarzyna Graczyk
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Magdalena Kostkiewicz
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland
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24
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Mylonakis E, Zhang EW, Bertrand PB, Gurol ME, Triant VA, Chaudet KM. Case 38-2024: A 22-Year-Old Woman with Headache, Fever, and Respiratory Failure. N Engl J Med 2024; 391:2148-2157. [PMID: 39774317 DOI: 10.1056/nejmcpc2100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Affiliation(s)
- Eleftherios Mylonakis
- From the Department of Medicine, Houston Methodist Hospital, and the Department of Medicine, Weill Cornell Medicine - both in Houston (E.M.); and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Massachusetts General Hospital, and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Harvard Medical School - both in Boston
| | - Eric W Zhang
- From the Department of Medicine, Houston Methodist Hospital, and the Department of Medicine, Weill Cornell Medicine - both in Houston (E.M.); and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Massachusetts General Hospital, and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Harvard Medical School - both in Boston
| | - Philippe B Bertrand
- From the Department of Medicine, Houston Methodist Hospital, and the Department of Medicine, Weill Cornell Medicine - both in Houston (E.M.); and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Massachusetts General Hospital, and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Harvard Medical School - both in Boston
| | - M Edip Gurol
- From the Department of Medicine, Houston Methodist Hospital, and the Department of Medicine, Weill Cornell Medicine - both in Houston (E.M.); and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Massachusetts General Hospital, and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Harvard Medical School - both in Boston
| | - Virginia A Triant
- From the Department of Medicine, Houston Methodist Hospital, and the Department of Medicine, Weill Cornell Medicine - both in Houston (E.M.); and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Massachusetts General Hospital, and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Harvard Medical School - both in Boston
| | - Kristine M Chaudet
- From the Department of Medicine, Houston Methodist Hospital, and the Department of Medicine, Weill Cornell Medicine - both in Houston (E.M.); and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Massachusetts General Hospital, and the Departments of Radiology (E.W.Z.), Medicine (P.B.B., V.A.T.), Neurology (M.E.G.), and Pathology (K.M.C.), Harvard Medical School - both in Boston
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25
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Mazzotta R, Orlandi M, Scheggi V, Marchionni N, Stefàno P. Coronary embolism in left-sided infective endocarditis. A retrospective analysis from a high-volume surgical centre and review of the literature. PLoS One 2024; 19:e0314718. [PMID: 39630824 PMCID: PMC11616836 DOI: 10.1371/journal.pone.0314718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 11/15/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Septic embolization is a common and potentially life-threatening complication of infective endocarditis (IE), with a prevalence of 22-50%. While acute coronary syndrome secondary to septic embolism is rare, it poses significant risks. AIMS This study examines coronary embolism (CE) in left-sided IE, describing clinical characteristics and outcomes. METHODS We retrospectively analysed 649 patients with non-device-related left-sided IE treated between January 2013 and December 2023 in a high-volume surgical centre. CE was diagnosed via ECG, clinical and laboratory signs of acute coronary syndrome, and confirmed by coronary angiography or magnetic resonance imaging. All patients were treated according to current European Society of Cardiology guidelines. A structured follow-up was performed. RESULTS Among patients included in the study, surgery was performed in 514 (79%) patients. Median follow-up duration was 4.7 years. CE occurred in 8 (1.2%) patients, and 6 (80%) of them were treated surgically. We found no significant differences in overall mortality rate between patients with or without CE (p = 0.65). Finally, cerebral embolism was significantly more frequent in patients with than without CE (75% vs 25%, p = 0.006, post-hoc power 87.8%). CONCLUSION CE is a rare but severe complication of IE, significantly associated with cerebral embolism. Early recognition and treatment are crucial to improve patient outcomes. Multicentre studies with larger patient populations are needed to further elucidate risk factors and enhance prognosis for CE in IE patients.
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Affiliation(s)
- Ruggero Mazzotta
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Orlandi
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valentina Scheggi
- Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pierluigi Stefàno
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Cardiac Surgery, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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26
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Dam SH, Ninh QN, Nguyen HC, Pham DT. A Case of Pulmonary Artery Endarteritis With Patent Ductus Arteriosus. Cureus 2024; 16:e76696. [PMID: 39898148 PMCID: PMC11782695 DOI: 10.7759/cureus.76696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2024] [Indexed: 02/04/2025] Open
Abstract
Right-sided heart endocarditis contributes to a small portion of infective endocarditis (IE) cases. Right-sided endocarditis related to undiagnosed congenital heart defects is even more scarce. Prompt diagnosis by transthoracic echocardiography (TTE), aggressive antibiotics from the beginning, and surgical removal of the vegetation for IE help prevent the risk of multi-organ failure and fatal pulmonary embolism. This is a case of a 38-year-old female, with normal medical history and recent vaginal birth at a district hospital four months ago. She was admitted to the hospital because of fever and continuous shortness of breath one month before admission. TTE detected vegetation (10x23 mm) on the left pulmonary artery and patent ductus arteriosus. A CT scan showed several abnormal mobile mixed-echo masses in the left pulmonary artery and partial pulmonary embolism. The patient had surgery to remove the vegetation and close the patent ductus arteriosus. The patient was stable after surgery and discharged two weeks after surgery. She continued two-week oral antibiotics at home and made a follow-up appointment one month later. Pulmonary artery endarteritis associated with patent ductus arteriosus is a rare lesion and has a high risk of death. The diagnosis should be considered in any febrile, septic patient with congenital heart disease. Removing vegetation and aggressive antibiotic treatment should be performed together to improve the outcome.
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Affiliation(s)
- Son H Dam
- Department of Cardiac and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, VNM
| | - Quynh N Ninh
- Department of Adult Cardiovascular Disease, Cardiovascular Center, E Hospital, Hanoi, VNM
| | - Huu C Nguyen
- Department of Cardiac and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, VNM
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, VNM
| | - Dat T Pham
- Department of Cardiac and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, VNM
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, VNM
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27
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Miller PE, Senman BC, Gage A, Carnicelli AP, Jacobs M, Rali AS, Senussi MH, Bhatt AS, Hollenberg SM, Kini A, Menon V, Grubb KJ, Morrow DA, American College of Cardiology Critical Care Cardiology Section. Acute Decompensated Valvular Disease in the Intensive Care Unit. JACC. ADVANCES 2024; 3:101402. [PMID: 39735779 PMCID: PMC11681797 DOI: 10.1016/j.jacadv.2024.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/15/2024] [Accepted: 10/01/2024] [Indexed: 12/31/2024]
Abstract
Acute decompensated valvular disease encompasses a group of complex and challenging conditions, which are often the primary reason for admission to the cardiac intensive care unit and can also complicate the management of other primary cardiac disorders. Critically ill patients with valvular disease also present unique diagnostic and management challenges. Historically, medical and percutaneous interventional therapies have been limited and surgery was the only definitive treatment; however, surgical risk can at times be prohibitive. High-quality evidence to direct management of acute valvular disorders in this population is lacking and societal guidelines largely do not address treatment options for critically ill patients with decompensated valvular disease. In this review, we discuss the clinical presentation and epidemiology of commonly encountered valvular diseases in the modern cardiac intensive care unit, highlight key pathophysiology, detail gaps in evidence, describe the pivotal role of multidisciplinary Heart Teams, and provide guidance for management.
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Affiliation(s)
- P. Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Ann Gage
- Centennial Heart, Centennial Medical Center, Nashville, Tennessee, USA
| | - Anthony P. Carnicelli
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark Jacobs
- Division of Cardiology, Stony Brook University, Stony Brook, New York, USA
| | - Aniket S. Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mourad H. Senussi
- Department of Cardiology, Baylor College of Medicine, Houston, Texas, USA
- Texas Heart Institute, Houston, Texas, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, California, USA
- Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, California, USA
| | - Steven M. Hollenberg
- Emory Heart & Vascular Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A. Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - American College of Cardiology Critical Care Cardiology Section
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Division of Cardiology, Duke University, Durham, North Carolina, USA
- Centennial Heart, Centennial Medical Center, Nashville, Tennessee, USA
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Division of Cardiology, Stony Brook University, Stony Brook, New York, USA
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Cardiology, Baylor College of Medicine, Houston, Texas, USA
- Texas Heart Institute, Houston, Texas, USA
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, California, USA
- Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, California, USA
- Emory Heart & Vascular Institute, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bhukya D, Naik P, Ramachandran M, Raja K, Munuswamy H, Ganesh RN, Pillai AA, Maurya DK, Keepanasseril A. Splenic artery aneurysm and infarction during pregnancy from infective endocarditis. BMJ Case Rep 2024; 17:e260923. [PMID: 39592179 DOI: 10.1136/bcr-2024-260923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2024] Open
Abstract
Rheumatic heart disease (RHD) remains the leading cardiac problem affecting pregnant women, especially in low- to middle-income countries. In nearly one-third of the cases, it is detected during pregnancy when they present with complications. Infective endocarditis (IE) in pregnancy is rare, with an incidence of 1 in 100 000 pregnancies, and carries high maternal and fetal morbidity and mortality. Embolisation of the infective vegetation can lead to inoculation of the arterial wall, causing aneurysm, infarction or abscess formation. Being an end artery, splenic artery aneurysm and infarct can complicate IE; it can even be lethal due to ruptured aneurysm with intraperitoneal bleed. We report a patient who presented with IE complicated with a splenic-artery aneurysm during pregnancy, successfully managed by a multidisciplinary team.
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Affiliation(s)
- Divya Bhukya
- Obstetrics and gynecology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Parvathi Naik
- Obstetrics and gynecology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Madhan Ramachandran
- Radio-diagnosis, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Kalayarasan Raja
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Hemachandren Munuswamy
- Cardiothoracic and vascular surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Dilip Kumar Maurya
- Obstetrics and gynecology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Anish Keepanasseril
- Obstetrics and gynecology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
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Chen Y, Ren J, Li F, Ye X, Wu Y. The antibiotic therapy containing contezolid successfully treated methicillin-sensitive Staphylococcus aureus infective endocarditis accompanied with cerebrovascular complications. BMC Infect Dis 2024; 24:1301. [PMID: 39543478 PMCID: PMC11566642 DOI: 10.1186/s12879-024-10157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 10/29/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND Staphylococcus aureus infective endocarditis (IE) in native valves is associated with high mortality rates and is prone to various complications, including embolic strokes, which often result in poor prognoses. Contezolid, a novel oxazolidinone antibiotic, exhibits superior therapeutic efficacy with a reduced risk of hematologic toxicity. However, there are currently no reports on the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) IE accompanied by cerebrovascular complications. CASE PRESENTATION We reported a young female patient with MSSA IE accompanied by cerebrovascular complications. She was diagnosed through blood culture, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cranial imaging, but the therapy using piperacillin-tazobactam and vancomycin failed. Therefore, the combination therapy of cefazolin and linezolid was applied, and her body temperature gradually returned to normal, and the infection symptoms were controlled. However, the platelets (PLT) dropped to 114 × 109/L, so contezolid was used as an alternative therapy. Subsequently, the PLT returned to normal. The patient received contezolid therapy for 3 weeks and was free of adverse events during the 2 years of follow-up. CONCLUSION This was the first case of MSSA IE accompanied by cerebrovascular complications in a young woman, who was successfully treated with an antibiotic regimen containing contezolid, without the need for surgical intervention, demonstrating remarkable efficacy and safety.
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Affiliation(s)
- Yong Chen
- Department of Respiration and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, P.R. China
| | - Jianwei Ren
- Department of Respiration and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, P.R. China
| | - Fei Li
- Department of Respiration and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, P.R. China
| | - Xiaofang Ye
- Department of Respiration and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, P.R. China
| | - Yuanxing Wu
- Department of Respiration and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, P.R. China.
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30
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Özcan G, Balkanay OO, Göksedef D, İpek G, Ömeroğlu SN. Late-Term Outcomes of Surgical Treatment of Infective Endocarditis. Surg Infect (Larchmt) 2024; 25:639-644. [PMID: 38995890 DOI: 10.1089/sur.2024.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Background: This study aims to evaluate the long-term outcomes of surgical interventions in patients with infective endocarditis (IE) who underwent surgical treatment and to determine the treatment approach for new patients. Patients and Methods: We retrospectively examined the long-term results of patients who underwent surgical treatment for IE between 2007 and 2017. The evaluation included late-term outcomes of IE surgery, surgical procedures, complications, the postoperative period, and clinical findings. Results: The study included 20 patients (12 male, 8 female) with a mean age of 45.1 ± 17.25. The most common cardiac risk factors for endocarditis development were the presence of prosthetic valves and heart valve disease. In addition, non-cardiac risk factors included chronic renal failure, systemic lupus erythematosus, and pemphigus vulgaris. Preoperative and postoperative laboratory findings were compared with in terms of morbidity and mortality, revealing no significant differences. The most prevalent preoperative laboratory findings were anemia (100%), elevated CRP (100%), and leukocytosis (50%). Anemia persisted as the most common laboratory finding in the postoperative evaluation. Conclusion: Our study identified comorbid chronic medical conditions, neurological complications because of IE, postoperative impaired left ventricular function, and treatment strategies such as monotherapy as poor prognostic factors in patients who underwent surgical treatment for IE. The management of IE is observed to be complex in the presence of comorbidities and complications, adversely affecting both survival and quality of life.
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Affiliation(s)
- Gülşah Özcan
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ozan Onur Balkanay
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Deniz Göksedef
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gökhan İpek
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Suat Nail Ömeroğlu
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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31
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Azimzadeh M, Alikhani MY, Sazmand A, Saberi K, Farahani Z, Kamali M, Haddadzadeh M, Safarpoor G, Nourian A, Mohammadi Y, Beikpour F, Salehi M, Greco G, Chomel B. Blood culture-negative endocarditis caused by Bartonella quintana in Iran. Sci Rep 2024; 14:26063. [PMID: 39478136 PMCID: PMC11525736 DOI: 10.1038/s41598-024-77757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 10/24/2024] [Indexed: 11/02/2024] Open
Abstract
Blood culture-negative endocarditis (BCNE) is a challenging disease because of the significant impact of delayed diagnosis on patients. In this study, excised heart valves and blood serum samples were collected from 50 BCNE patients in two central hospitals in Tehran, Iran. Sera were tested by IFA for the presence of IgG and IgM antibodies against Bartonella quintana and B. henselae. Genomic DNA extracted from the heart valves was examined for Bartonella-specific ssrA gene in a probe-based method real-time PCR assay. Any positive sample was Sanger sequenced. IgG titer higher than 1024 was observed in only one patient and all 50 patients tested negative for Bartonella IgM. By real-time PCR, the ssrA gene was detected in the valve of one patient which was further confirmed to be B. quintana. Bartonella-like structures were observed in transmission electron microscopy images of that patient. We present for the first time the involvement of Bartonella in BCNE in Iran. Future research on at-risk populations, as well as domestic and wild mammals as potential reservoirs, is recommended.
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Affiliation(s)
- Masoud Azimzadeh
- Department of Microbiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, Hamadan University of Medical Sciences, Hamadan, Iran.
- Infectious Disease Research Center, Avicenna Institute of Clinical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Alireza Sazmand
- Department of Pathobiology, Faculty of Veterinary Medicine, Bu-Ali Sina University, Hamedan, 6517658978, Iran.
| | - Kianoush Saberi
- Department of Anesthesia, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Farahani
- Department of Nursery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Monireh Kamali
- Department of Infectious Diseases, Shaheed Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Haddadzadeh
- Department of Cardiac Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, 8915887856, Iran
| | - Gholamreza Safarpoor
- Department of Cardiovascular Surgery, School of Medicine, Farshchian Cardiovascular Subspecialty Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Nourian
- Department of Pathobiology, Faculty of Veterinary Medicine, Bu-Ali Sina University, Hamedan, 6517658978, Iran
| | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzad Beikpour
- Department of Pediatrics, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Mehrdad Salehi
- Department of Cardiovascular and Transplantation Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Grazia Greco
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Valenzano, 70010, Bari, Italy
| | - Bruno Chomel
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, USA
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32
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Tang M, Lu X, Li Y, Chen Y, Xie Y. Two Cases of Listeria monocytogenes-Induced Infective Endocarditis. Infect Drug Resist 2024; 17:4567-4575. [PMID: 39464832 PMCID: PMC11505490 DOI: 10.2147/idr.s473359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/07/2024] [Indexed: 10/29/2024] Open
Abstract
Listeria monocytogenes is a prevalent gram-positive intracellular zoonotic pathogen that is frequently associated with foodborne illnesses and opportunistic infections. This bacterium is responsible for causing various clinical manifestations, including bacteremia, meningitis, and encephalitis, and is primarily transmitted through contaminated food consumption. This study presents two cases of severe endocarditis in patients with heart valve disease caused by L. monocytogenes. Infection was confirmed by blood culture and pathogen culture of the valve pus. Early detection, clinical suspicion, and appropriate treatment are crucial for improving the prognosis of patients with listeriosis. The combination of ampicillin and aminoglycosides remains the most effective treatment for listeriosis.
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Affiliation(s)
- Mengli Tang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xingbing Lu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuxiao Li
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuzuo Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yi Xie
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Dinges C, Hammerer M, Schörghofer N, Knapitsch C, Hecke G, Klaus S, Steindl J, Rezar R, Seitelberger R, Hoppe UC, Hergan K, Boxhammer E, Scharinger B. Impact of Psoas Muscle Area Index on Short- and Mid-Term Mortality in Patients Undergoing Valve Surgery for Infective Endocarditis: A Retrospective Analysis. Diagnostics (Basel) 2024; 14:2259. [PMID: 39451582 PMCID: PMC11506453 DOI: 10.3390/diagnostics14202259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 10/07/2024] [Accepted: 10/09/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Sarcopenia, characterized by the loss of skeletal muscle mass, is an emerging comorbidity associated with poor outcomes in cardiovascular surgery. Its impact on mortality in patients undergoing valve surgery for infective endocarditis (IE) remains underexplored. This study investigates the relationship between sarcopenia, measured by the Psoas muscle area index (PMAi), and mortality in patients with IE undergoing valve surgery. Materials and Methods: We retrospectively analyzed 68 patients with IE who underwent valve surgery at a tertiary care center from 2013 to 2021. Sarcopenia was defined as being in the lowest quartile of PMAi, measured via preoperative computed tomography (CT). Baseline characteristics, survival outcomes, and factors influencing mortality were analyzed using Kaplan-Meier survival curves and Cox proportional hazards regression. The predictive value of PMAi for 1-year and 3-year mortality was assessed via receiver operating characteristic (ROC) curves. Results: Sarcopenia was strongly associated with increased mortality at both 1-year (HR: 0.378, p = 0.010) and 3-year follow-ups (HR: 0.457, p = 0.012). Female sex (OR: 275.748, p < 0.001) and older age (OR: 9.995, p = 0.003) were significant predictors of sarcopenia. Chronic kidney insufficiency (CKI) and the use of heart failure medication therapy also significantly impacted survival outcomes. Conclusions: Sarcopenia is a strong independent predictor of short- and mid-term mortality in patients undergoing valve surgery for IE. Routine radiological assessment of sarcopenia using PMAi could improve risk stratification and guide preoperative interventions. Tailored management strategies, especially in older women and patients with CKI, may enhance outcomes in this high-risk population.
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Affiliation(s)
- Christian Dinges
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (C.D.)
| | - Matthias Hammerer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Nikolaos Schörghofer
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (B.S.)
| | - Christoph Knapitsch
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (B.S.)
| | - Gretha Hecke
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (B.S.)
| | - Sophie Klaus
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (B.S.)
| | - Johannes Steindl
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (C.D.)
| | - Richard Rezar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Rainald Seitelberger
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (C.D.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (B.S.)
| | - Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Bernhard Scharinger
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (B.S.)
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Nuthalapati U, Bathinapattla MR, Cardoso RP, Jesi NJ, Singh K, Moradi I, Gostomczyk K, Afzal M, Omer MB, Mian ZR, Patel S, Sachdeva P, Malik MN, Abbas M, Singh J, Shafique MA. Mitral valve repair and replacement in infectious endocarditis: a systematic review and meta-analysis of clinical outcome. Egypt Heart J 2024; 76:134. [PMID: 39365370 PMCID: PMC11452577 DOI: 10.1186/s43044-024-00564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 09/19/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) poses significant clinical challenges, often necessitating surgical intervention for improved patient outcomes. The choice between mitral valve repair (MVP) and mitral valve replacement (MVR) is crucial in managing IE. This systematic review and meta-analysis aims to compare the effectiveness of MVP and MVR in treating IE, focusing on outcomes such as postoperative bleeding, mortality, recurrent endocarditis, and stroke. MAIN TEXT A comprehensive literature search was conducted following PRISMA guidelines. Studies directly comparing MVP and MVR in IE patients were included. Data extraction and quality assessment were performed, and meta-analysis was conducted using RevMan software. Thirty-two studies involving 82,123 patients were included. MVP was associated with significantly lower rates of postoperative bleeding (OR: 0.58, 95% CI: 0.40-0.84) and reduced long-term mortality (OR: 0.40, 95% CI: 0.32-0.51) compared to MVR. However, MVR showed lower rates of recurrent endocarditis. MVP was also associated with a decreased likelihood of postoperative stroke (OR: 0.52, 95% CI: 0.40-0.68).2, 4 CONCLUSIONS: MVP demonstrates advantages over MVR in reducing postoperative bleeding, long-term mortality, and stroke risk in IE patients. However, individual patient factors and surgical expertise must be considered in treatment decisions. Further research, including randomized controlled trials, is needed to validate these findings and refine treatment algorithms for IE management.
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Affiliation(s)
- Umesh Nuthalapati
- Ivano Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | | | - Nusrat Jahan Jesi
- Shaheed Syed Nazrul Islam Medical College and Hospital, Kishoregonj, Bangladesh
| | | | - Iman Moradi
- School of Medicine, St. Georges' University, St. George's, Grenada
| | - Karol Gostomczyk
- Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maham Afzal
- Fatima Jinnah Medical University, Lahore, Pakistan
| | | | | | - Soham Patel
- Teaching University Geomedi, Tbilisi, Georgia
| | | | | | | | - Jugraj Singh
- Verde Valley Medical Center, Cottonwood, AZ, 86326, USA
| | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan.
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35
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Li J, Zhao J, Sun N, Zhang L, Su Q, Xu W, Luo X, Gao Z, Zhu K, Zhou R, Qin Z. Preoperative fibrinogen level predicts the risk and prognosis of patients with native valve infective endocarditis undergoing valve surgery. PeerJ 2024; 12:e18182. [PMID: 39346087 PMCID: PMC11438427 DOI: 10.7717/peerj.18182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 09/05/2024] [Indexed: 10/01/2024] Open
Abstract
Aim The aim of this study was to assess the clinical significance and prognostic value of the preoperative fibrinogen (FBG) level in patients with native valve infective endocarditis (NVIE) who underwent valve surgery. Methods This retrospective study included a total of 163 consecutive patients who were diagnosed with NVIE and underwent valve surgery from January 2019 to January 2022 in our hospital. The primary endpoint was all-cause mortality. Results All-cause mortality was observed in 9.2% of the patients (n = 15). Body mass index (BMI) was lower in the survival group (p = 0.025), whereas FBG (p = 0.008) and platelet count (p = 0.044) were significantly greater in the survival group than in the death group. Multivariate Cox proportional hazards analysis revealed that FBG (HR, 0.55; 95% CI, [0.32-0.94]; p = 0.029) was an independent prognostic factor for all-cause mortality. Furthermore, Kaplan‒Meier survival curve analysis revealed that patients with low FBG levels (<3.28 g/L) had a significantly greater mortality rate (p = 0.034) than did those with high FBG levels (>3.99 g/L). In the trend analysis, the FBG tertiles were significantly related to all-cause mortality in all three adjusted models, and the p values for trend were 0.017, 0.016, and 0.028, respectively. Conclusion Preoperative FBG may serve as a prognostic factor for all-cause mortality, and an FBG concentration less than 3.28 g/L was associated with a greater risk of all-cause mortality in NVIE patients undergoing valve surgery.
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Affiliation(s)
- Jia Li
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Junyong Zhao
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ning Sun
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lijiao Zhang
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Qing Su
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wei Xu
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaolin Luo
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhichun Gao
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Keting Zhu
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Renjie Zhou
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
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36
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Milligan R, Stewart V, Beresford A, Marley J. An audit of pre-operative dental radiographs in patients who received no pre-operative dental input before cardiovalvular surgery. Br Dent J 2024:10.1038/s41415-024-7851-4. [PMID: 39304790 DOI: 10.1038/s41415-024-7851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 09/22/2024]
Abstract
Purpose To radiographically characterise dental disease burden and related characteristics of referred patients awaiting cardiovalvular surgery (CVS) in the context of infective endocarditis (IE) risk.Methods Radiographic evidence of dental disease levels was assessed for patients referred for dental assessment pre-CVS using available orthopantomographs (OPTs) prescribed by the cardiology team. This group did not receive any pre-CVS dental intervention or treatment.Results The majority of OPTs were Quality Standard 2 (87.5%). There was radiographic evidence of dentoalveolar disease in those patients proceeding to CVS. Periodontal disease was most prominent, with 79% of patients having advanced bone loss. The mean number of apical lesions was 0.71. Overall decayed, missing, and filled teeth score was 16.4, along with mean missing teeth scores of 7.9. None of the patients have so far developed IE at a minimum of six-month follow-up.Conclusions In our context, the quality of the radiographs requested by non-dental clinicians and delivered by non-dental-school-based radiographic departments is suboptimal and needs to be addressed. This audit should help to inform the debate around the timing and delivery of evidence-based, specialist dental care for CVS patients.
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Affiliation(s)
| | | | | | - John Marley
- School of Dentistry, Belfast, Northern Ireland, UK
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Cai S, Zhou C, Shan Y, Bao R, Hu L, Pan J, Wang C, Yin J, Hu B. Epidemiology, clinical characteristics, and outcome of infective endocarditis due to Abiotrophia and Granulicatella in a Tertiary Hospital in China, 2015-2023: a retrospective study. BMC Infect Dis 2024; 24:1022. [PMID: 39304837 DOI: 10.1186/s12879-024-09943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Abiotrophia (ABI) and Granulicatella (GRA) are rare causative pathogens in infective endocarditis (IE). This study aims to describe the epidemiology, clinical characteristics, and outcome of ABI/GRA-IE. The main features of ABI/GRA-IE were compared with Viridans group streptococci (VGS) IE. METHODS From January 2015 to December 2023, a total of 1531 definite IE in Zhongshan Hospital, Fudan University, Shanghai, China were retrospectively enrolled in this study. Clinical and laboratory data were collected. RESULTS Forty-five ABI/GRA-IE cases were identified, representing 2.9% of all IE cases in Zhongshan Hospital between 2015 and 2023, compared to 20.1% of VGS-IE. ABI and GRA IE shared similar clinical characteristics. Congenital valvulopathy was reported in 21 (46.7%) ABI/GRA-IE and 85 (28.8%) VGS-IE (P = 0.025). Pulmonary valve was more frequently affected in ABI/GRA-IE (6 [13.3%]) than VGS-IE (7 [2.4%]) (P = 0.002). Congestive heart failure was observed in 30 (66.7%) ABI/GRA-IE and 103 (34.9%) VGS-IE (P < 0.001). Systemic embolization excluding central nervous system (CNS) occurred in 13 (28.9%) ABI/GRA-IE and 39 (13.2%) VGS-IE (P = 0.012). In-hospital mortality was reported as 4.4% in ABI/GRA-IE and 3.7% in VGS-IE (P = 0.854). CONCLUSION GRA/ABI-IE was approximately one-seventh as prevalent as VGS-IE. Congestive heart failure and systemic embolization (excluding CNS) were more frequent in GRA/ABI-IE compared to VGS-IE. Mortality of ABI/GRA-IE in this study was comparable to that of VGS-IE and lower than previously reported results.
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Affiliation(s)
- Sishi Cai
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chunmei Zhou
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuzhang Shan
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Bao
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijuan Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jue Pan
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Dingen H, Jordal S, Bratt S, Aukrust P, Busund R, Jakobsen Ø, Dalén M, Ueland T, Svenarud P, Haaverstad R, Saeed S, Risnes I. Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicenter case-control study. BMC Infect Dis 2024; 24:913. [PMID: 39227795 PMCID: PMC11370320 DOI: 10.1186/s12879-024-09782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/21/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Aortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease. METHODS Between January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models. RESULTS The mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36-5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43-2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78). CONCLUSIONS In this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.
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Affiliation(s)
- Håvard Dingen
- Department of Internal Medicine, Stord Hospital, Stord, Norway
- Department of Medicine, Section of Infectious diseases, Haukeland University Hospital, Bergen, Norway
| | - Stina Jordal
- Department of Medicine, Section of Infectious diseases, Haukeland University Hospital, Bergen, Norway
| | - Sorosh Bratt
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pål Aukrust
- Research Institute of Internal Medicine & Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rolf Busund
- Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway
| | - Øyvind Jakobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway
| | - Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Thor Ueland
- Research Institute of Internal Medicine & Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Thrombosis Research Center (TREC), Division of internal medicine, University Hospital of North Norway, Tromsø, Norway
| | - Peter Svenarud
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Rune Haaverstad
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Science, Medical Faculty, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway.
| | - Ivar Risnes
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Ullevål, Oslo, Norway
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Myint N. A Case of Native Mitral Valve Infective Endocarditis in a Chronic Dialysis Patient: The Importance of Vigilance. Cureus 2024; 16:e69924. [PMID: 39439645 PMCID: PMC11495512 DOI: 10.7759/cureus.69924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2024] [Indexed: 10/25/2024] Open
Abstract
This case involves native mitral valve infective endocarditis in a chronic hemodialysis patient resulting from a catheter-related bloodstream infection (CRBSI). Infective endocarditis in dialysis patients is more common and is associated with higher mortality rates compared to non-dialysis patients. It is also a serious complication of tunneled dialysis catheter infections. The presentation and diagnosis of infective endocarditis in chronic dialysis patients can be challenging and may often be overlooked. This case highlights the importance of maintaining a strong clinical suspicion for infective endocarditis when such patients deteriorate from their baseline status or deviate from the expected response to appropriate treatment.
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Affiliation(s)
- Nyan Myint
- Internal Medicine, Meharry Medical College, Nashville, USA
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Kumar A, Casamassimo P, Kovalchin J, Claman D, Peng J, McDaniel J, Hunt WG, Wong CA. The changing profile of infective endocarditis: A multi-year retrospective study for dentists. Int J Paediatr Dent 2024; 34:673-679. [PMID: 38297423 DOI: 10.1111/ipd.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Infective endocarditis (IE) has high morbidity and mortality and is often attributed to dental procedures. AIM This study characterized variables related to paediatric IE in a paediatric hospital cohort. DESIGN A retrospective review of medical records, from January 1, 2008, to January 1, 2020, to examine demographic, medical and dental history, and risk factors associated with children diagnosed with IE at Nationwide Children's Hospital. RESULTS Of the 242 patients who were admitted with tentative IE diagnoses, 67 met the inclusion criteria: 46 (69%) had underlying cardiac conditions and 21 (31%) had not. One-third had an infection with S. aureus and viridans streptococci. Age was significantly associated with intracardiac devices in children with IE. Mean hospitalization was 25 days, and the mortality was 6 (9%); 41(61%) required surgery for causative defects, and 24 (32%) had dental consultation during admission. CONCLUSION Although cardiac-related conditions were present in most cases, IE occurred in patients without cardiac factors.
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Affiliation(s)
- Ashok Kumar
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Paul Casamassimo
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - John Kovalchin
- Section of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Daniel Claman
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jin Peng
- Research Information Solutions and Innovation Research & Development, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jodee McDaniel
- Division of Pediatric Dentistry and Division of Dental Hygiene, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - W Garrett Hunt
- Section of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Chloe A Wong
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
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Pereira SJ. Commentary: Complex valve endocarditis: The importance of early surgical timing with cerebral emboli and a multidisciplinary endocarditis team. J Thorac Cardiovasc Surg 2024; 168:843-844. [PMID: 37977209 DOI: 10.1016/j.jtcvs.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Sara J Pereira
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
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Oliveira GB, Fae IG, Carvalho VT, Pinto PHOM, Duque RAS, Gelape FA, Cambraia FSL, Costa GL, Diamante LC, Bráulio R, Gelape CL, Sousa MR, Ferrari TCA, Nunes MCP. Predictors of Mortality in Patients with Cardiac Device-Related Infective Endocarditis. Trop Med Infect Dis 2024; 9:193. [PMID: 39330882 PMCID: PMC11436160 DOI: 10.3390/tropicalmed9090193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
Infective endocarditis (IE) associated with implantable cardiac devices (ICD) is a serious disease with high mortality rates. The increased number of ICD implants has led to increased ICD infection rates. The aim of this study was to characterize clinical, laboratory profiles and the prognosis of cardiac-device-related endocarditis (CDIE), as well as to identify predictors of in-hospital death. A total of 274 patients with IE were included in a prospective cohort (2007-2019). From these, 82 patients (30%) had CDIE (46 pacemakers, 23 cardioverter defibrillators, and 13 cardiac resynchronization therapy devices). Predisposed conditions; clinical, laboratory and echocardiographic parameters; etiologic agents; and in-hospital outcomes were evaluated. The mean age was 55.8 ± 16.4 years, where 64.6% were male. Among the clinical manifestations at diagnosis, the most prevalent were heart failure (67.9%), fever (60.5%), anorexia/hyporexia (44.4%), and heart murmur (37.5%). The median serum C-reactive protein (CRP) level at diagnosis was 63 mg/L (interquartile range [IQR] 20-161). Etiological agents were identified through positive blood cultures in 55% of cases. The main etiologic agents were negative-coagulase staphylococci (19.5%) and Staphylococcus aureus (18.3%). Vegetation was identified in 74 patients (90.1%). In-hospital mortality was 28%. CRP concentrations at diagnosis were identified as markers of disease severity (odds ratio [OR] 1.006; 95%CI 1.001-1.011; p = 0.016), and the worsening of heart failure was associated with unfavorable outcomes (OR 3.105; 95%CI 1.397-6.902; p = 0.005). Unlike what is traditionally accepted, CDIE does not have a better prognosis.
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Affiliation(s)
- Gustavo Brandão Oliveira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
| | - Isabela Galizzi Fae
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
| | - Vinícius Tostes Carvalho
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Pedro Henrique Oliveira Murta Pinto
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
| | - Roni Arley Silva Duque
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.A.S.D.); (M.R.S.)
| | - Fernanda Alves Gelape
- Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte 30130-110, MG, Brazil;
| | - Fernanda Sophya Leite Cambraia
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Guilherme Lelis Costa
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Lucas Chaves Diamante
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Renato Bráulio
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.B.); (C.L.G.)
| | - Cláudio Léo Gelape
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.B.); (C.L.G.)
| | - Marcos Roberto Sousa
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.A.S.D.); (M.R.S.)
| | - Teresa Cristina Abreu Ferrari
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Maria Carmo Pereira Nunes
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
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d'Almeida S, Reischmann K, Andreß S, Felbel D, Stephan T, Hay B, Rohlmann F, Buckert D, Rottbauer W, Markovic S. Evaluating the Duke Criteria for infectious endocarditis in a single-center retrospective study. Sci Rep 2024; 14:19524. [PMID: 39174590 PMCID: PMC11341858 DOI: 10.1038/s41598-024-70196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
The Duke Criteria have shaped the way infectious endocarditis (IE) is diagnosed in the last 30 years. This study aims to evaluate their current validity and importance in the diagnostic of IE. A retrospective cohort study was conducted on 163 consecutive patients who presented at the University Hospital in Ulm (Germany) with clinical suspicion of IE between 2009 and 2019. With patients' medical records we differentiated between definitive endocarditis (DIE), possible endocarditis (PIE) and rejected endocarditis (RIE) and assessed the validity of the Duke Criteria in comparison to the final discharge diagnosis. We then tried to identify new potential parameters as an addition to the current valid Duke Criteria. The validity of the Duke Criteria improves with the length of hospitalization (especially cardiac imaging criterion, RIE 33.3%, PIE 31.6% and DIE 41.9%, p = 0.622 at admission and RIE 53.3%, PIE 68.4%, DIE 92.2%, p < 0.001 at discharge). At admission, overall sensitivity and specificity were respectively 29.5 and 91.2% in the DIE group. At discharge, sensitivity in the DIE group rose to 77.5% and specificity decreased to 79.4%. Of all screened metrics, microhematuria (p = 0.124), leukocyturia, (p = 0.075), younger age (p = 0.042) and the lack of rheumatoid disease (p = 0.011) showed a difference in incidence (p < 0.2) when comparing DIE and RIE group. In multivariate regression only microhematuria qualified as a potential sixth minor criterion at admission. Even with the latest technological breakthroughs our findings suggest that the Duke Criteria continue to hold value in the accurate assessment of IE. Future efforts must shorten the time until diagnosis.
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Affiliation(s)
- Sascha d'Almeida
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany.
| | - Kathrin Reischmann
- Department of Anesthesiology and Intensive Care, Ulm University Medical Center, Ulm, Germany
| | - Stefanie Andreß
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Dominik Felbel
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Tilman Stephan
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Birgit Hay
- Department of Medical Biometry and Statistics, Ulm University Medical Center, Ulm, Germany
| | - Friederike Rohlmann
- Department of Medical Biometry and Statistics, Ulm University Medical Center, Ulm, Germany
| | - Dominik Buckert
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Sinisa Markovic
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
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Ackermann P, Marin-Cuartas M, Weber C, De La Cuesta M, Lichtenberg A, Petrov A, Hagl C, Aubin H, Matschke K, Diab M, Luehr M, Akhyari P, Tugtekin SM, Saha S, Doenst T, Wahlers T, Borger MA, Misfeld M. Sex-related differences in patients with infective endocarditis requiring cardiac surgery: insights from the CAMPAIGN Study Group. Eur J Cardiothorac Surg 2024; 66:ezae292. [PMID: 39073913 DOI: 10.1093/ejcts/ezae292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/22/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES Sex-related differences play a role in cardiovascular disease-related outcomes. There is, however, a knowledge gap regarding sex-specific differences in patients with infective endocarditis (IE)-requiring surgical treatment. This study aims to analyse sex-related differences in the clinical presentation, treatment and clinical outcomes of patients with IE-requiring surgical treatment from the multicentric Germany-wide CAMPAIGN registry. METHODS Patients with IE who underwent cardiac surgery between 1994 and 2018 at six German centres were retrospectively analysed. Outcomes were compared based on patients' sex. Primary outcomes were 30-day mortality and mid-term survival. RESULTS A total of 4917 patients were included in the analysis (1364 female [27.7%] and 3553 male [72.3%]). Female patients presented with more comorbidities and higher surgical risk (EuroScore II 12.0% vs 10.0%, P < 0.001). The early postoperative course of female patients was characterized by longer ventilation times (20.0 h vs 16.0 h; P = 0.004), longer intensive care unit stay (4.0 days vs 3.0 days; P < 0.001), and more frequent new-onset dialysis (265 [20.3%] vs 549 [16.3%]; P = 0.001). The 30-day mortality was 13.8% and 15.5% in female and male patients, respectively (P = 0.06). The estimated mid-term survival was significantly higher amongst male patients (56.1% vs 45.4%; Log-rank P < 0.001). Female sex was an independent predictor of mid-term mortality (HR 1.2 [95% CI 1.0-1.4], P = 0.01). CONCLUSIONS Male patients more frequently undergo cardiac surgery for IE. However, female patients have a higher surgical risk profile and subsequently an increased early postoperative morbidity, but with similar 30-day mortality compared with male patients. The estimated mid-term survival is lower amongst female patients.
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Affiliation(s)
- Paula Ackermann
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Manuela De La Cuesta
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Asen Petrov
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Mahmoud Diab
- Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg, Rontenburg an der Fulda, Germany
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, RWTH Aachen, Aachen, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Torsten Doenst
- Department of Cardiac Surgery, University Hospital of Jena, Jena, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, RPAH, Sydney, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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45
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Marin-Cuartas M, De La Cuesta M, Weber C, Krinke E, Lichtenberg A, Petrov A, Hagl C, Aubin H, Matschke K, Diab M, Luehr M, Akhyari P, Schnackenburg P, Tugtekin SM, Saha S, Doenst T, Wahlers T, Borger MA, Misfeld M. Outcomes following heart valve surgery in patients with infective endocarditis and preoperative septic cerebral embolism: insights from the CAMPAIGN study group. Eur J Cardiothorac Surg 2024; 66:ezae295. [PMID: 39087593 DOI: 10.1093/ejcts/ezae295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/31/2024] [Accepted: 07/31/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES This study aimed to analyse the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis undergoing valve surgery. METHODS Retrospective multicentric study based on the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry comprising patients with infective endocarditis who underwent valve surgery between 1994 and 2018 at 6 German centres. Patients were divided into 2 groups for statistical comparison according to the presence or absence of preoperative septic cerebral embolism. Propensity score matching was performed for adjusted comparisons of postoperative outcomes. Primary outcomes were 30-day mortality and estimated 5-year survival. RESULTS A total of 4917 patients were included in the analysis, 3909 (79.5%) patients without and 1008 (20.5%) patients with preoperative septic cerebral embolism. Patients with preoperative septic cerebral embolism had more baseline comorbidities. Mitral valve endocarditis (44.1% vs 33.0% P < 0.001), large vegetations >10 mm (43.1% vs 30.0%, P < 0.001), and Staphylococcus species infection (42.3% vs 21.3%, P < 0.001) were more frequent in the cerebral embolism group. Among patients with preoperative cerebral embolism, 286 (28.4%) patients had no stroke signs (silent stroke). After matching (1008 matched pairs), there was no statistically significant difference in 30-day mortality (20.1% vs 22.8%; P = 0.14) and 5-year survival (47.8% vs 49.1%; stratified log-rank P = 0.77) in patients with and without preoperative cerebral embolism, respectively. CONCLUSIONS Preoperative septic cerebral embolism in patients with infective endocarditis requiring valve surgery does not negatively affect early or late mortality; therefore, it should not play a major role in deciding if surgery is to be performed.
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Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Manuela De La Cuesta
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Elisabeth Krinke
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Asen Petrov
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Mahmoud Diab
- Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg, Rontenburg an der Fulda, Germany
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, RWTH Aachen, Aachen, Germany
| | | | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Torsten Doenst
- Department of Cardiac Surgery, University Hospital of Jena, Jena, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, RPAH, Sydney, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
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46
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Franz M, Aburahma K, Ius F, Ali-Hasan-Al-Saegh S, Boethig D, Hertel N, Zubarevich A, Kaufeld T, Ruhparwar A, Weymann A, Salman J. Minimally Invasive Surgery through Right Mini-Thoracotomy for Mitral Valve Infective Endocarditis: Contraindicated or Safely Possible? J Clin Med 2024; 13:4182. [PMID: 39064222 PMCID: PMC11278371 DOI: 10.3390/jcm13144182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Mitral valve infective endocarditis (IE) still has a high mortality. Minimally invasive mitral valve surgery (MIMVS) is technically more challenging, especially in patients with endocarditis. Here, we compare the early postoperative outcome of patients with endocarditis and other indications for MIMVS. Methods: Two groups were formed, one consisting of patients who underwent surgery because of mitral valve endocarditis (IE group: n = 75) and the other group consisting of patients who had another indication for MIMVS (non-IE group: n = 862). Patients were observed for 30 postoperative days. Data were retrospectively reviewed and collected from January 2011 to September 2023. Results: Patients from the IE group were younger (60 vs. 68 years; p < 0.001) and had a higher preoperative history of stroke (26% vs. 6%; p < 0.001) with neurological symptoms (26% vs. 9%; p < 0.001). No difference was seen in overall surgery time (211 vs. 206 min; p = 0.71), time on cardiopulmonary bypass (137 vs. 137 min; p = 0.42) and aortic clamping time (76 vs. 78 min; p = 0.42). Concerning postoperative data, the IE group had a higher requirement of erythrocyte transfusion (2 vs. 0; p = 0.041). But no difference was seen in the need for a mitral valve redo procedure, bleeding, postoperative stroke, cerebral bleeding, new-onset dialysis, overall intubation time, sepsis, pacemaker implantation, wound healing disorders and 30-day mortality. Conclusions: Minimally invasive mitral valve surgery in patients with mitral valve endocarditis is feasible and safe. Infective endocarditis should not be considered as a contraindication for MIMVS.
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Affiliation(s)
| | | | | | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.W.); (J.S.)
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47
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Kogularasu S, Lin WC, Lee YY, Huang BW, Chen YL, Chang-Chien GP, Sheu JK. Advancements in electrochemical biosensing of cardiovascular disease biomarkers. J Mater Chem B 2024; 12:6305-6327. [PMID: 38912548 DOI: 10.1039/d4tb00333k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Cardiovascular diseases (CVDs) stand as a predominant global health concern, introducing vast socioeconomic challenges. In addressing this pressing dilemma, enhanced diagnostic modalities have become paramount, positioning electrochemical biosensing as an instrumental innovation. This comprehensive review navigates the multifaceted terrain of CVDs, elucidating their defining characteristics, clinical manifestations, therapeutic avenues, and intrinsic risk factors. Notable emphasis is placed on pivotal diagnostic tools, spotlighting cardiac biomarkers distinguished by their unmatched clinical precision in terms of relevance, sensitivity, and specificity. Highlighting the broader repercussions of CVDs, there emerges an accentuated need for refined diagnostic strategies. Such an exploration segues into a profound analysis of electrochemical biosensing, encapsulating its foundational principles, diverse classifications, and integral components, notably recognition molecules and transducers. Contemporary advancements in biosensing technologies are brought to the fore, emphasizing pioneering electrode architectures, cutting-edge signal amplification processes, and the synergistic integration of biosensors with microfluidic platforms. At the core of this discourse is the demonstrated proficiency of biosensors in detecting cardiovascular anomalies, underpinned by empirical case studies, systematic evaluations, and clinical insights. As the narrative unfolds, it addresses an array of inherent challenges, spanning intricate technicalities, real-world applicability constraints, and regulatory considerations, finally, by casting an anticipatory gaze upon the future of electrochemical biosensing, heralding a new era of diagnostic tools primed to revolutionize cardiovascular healthcare.
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Affiliation(s)
- Sakthivel Kogularasu
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833301, Taiwan.
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833301, Taiwan
| | - Wan-Ching Lin
- Department of Neuroradiology, E-da Hospital, I-Shou University, Kaohsiung 84001, Taiwan
- Department of Neurosurgery, E-da Hospital, I-Shou University, Kaohsiung 84001, Taiwan
| | - Yen-Yi Lee
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833301, Taiwan.
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833301, Taiwan
- Institute of Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833301, Taiwan
| | - Bo-Wun Huang
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung 833301, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Guo-Ping Chang-Chien
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833301, Taiwan.
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833301, Taiwan
- Institute of Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833301, Taiwan
| | - Jinn-Kong Sheu
- Department of Photonics, National Cheng Kung University, Tainan 701, Taiwan.
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48
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Hopkins S, Gajagowni S, Qadeer Y, Wang Z, Virani SS, Meurman JH, Leischik R, Lavie CJ, Strauss M, Krittanawong C. More than just teeth: How oral health can affect the heart. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 43:100407. [PMID: 38873102 PMCID: PMC11169959 DOI: 10.1016/j.ahjo.2024.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
Epidemiological evidence has revealed a potential relationship between periodontal disease and cardiovascular disease (CVD). Consensus regarding a link between these pathologies remains elusive, however, largely secondary to the considerable overlap between risk factors and comorbidities common to both disease processes. This review article aims to update the evidence for an association by summarizing the evidence for causality between periodontitis and comorbidities linked to CVD, including endocarditis, hypertension (HTN), atrial fibrillation (AF), coronary artery disease (CAD), diabetes mellitus (DM) and hyperlipidemia (HLD). This article additionally discusses the role for periodontal therapy to improved management of the comorbidities, with the larger goal of examining the value of periodontal therapy on reduction of CVD risk. In doing so, we endeavor to further the understanding of the commonality between periodontitis, and CVD.
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Affiliation(s)
- Steven Hopkins
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Yusuf Qadeer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Salim S. Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Office of the Vice Provost (Research), The Aga Khan University, Karachi 74800, Pakistan
| | - Jukka H. Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Roman Leischik
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA
| | - Markus Strauss
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
- Department of Cardiology I- Coronary and Periphal Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
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49
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Jesus A, Lopes M, Martins P, Pires A. A Case Report of Acute Infective Endocarditis Caused by Aggregatibacter aphrophilus Involving the Tricuspid Valve. Cureus 2024; 16:e64412. [PMID: 39130966 PMCID: PMC11317068 DOI: 10.7759/cureus.64412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
We report a case of a 16-year-old male with tricuspid valve infective endocarditis caused by Aggregatibacter aphrophilus and complicated by pulmonary septic embolisms. Multiple antimicrobial therapy was unsuccessful and surgical management was required. In this report, the authors highlight the importance of a high index of suspicion regarding the diagnosis of endocarditis and its possible complications.
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Affiliation(s)
- Ana Jesus
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
| | - Manuela Lopes
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
| | - Paula Martins
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
- Pediatric Cardiology, Faculdade de Medicina da Universidade de Coimbra, Coimbra, PRT
| | - António Pires
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
- Pediatric Cardiology, Faculdade de Medicina da Universidade de Coimbra, Coimbra, PRT
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50
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Hatab T, Zaid S, Thakkar SJ, Bou Chaaya RG, Goel SS, Reardon MJ. Infection of Transcatheter Valvular Devices. Curr Cardiol Rep 2024; 26:767-775. [PMID: 38806975 DOI: 10.1007/s11886-024-02076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology. RECENT FINDINGS Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors. Younger age, male gender, and certain comorbidities emerge as patient-related risk factors. Procedure-related factors include intervention location, valve type, and technical aspects. Microbiologically, Staphylococcus aureus, Viridans Group Streptococcus, and Enterococcus are frequently encountered pathogens. TAVR-IE and TEER-IE diagnosis involves a multimodal imaging approach due to limitations in echocardiography. Blood cultures and imaging aid identification, with Fluorescence in situ hybridization is showing promise. Treatment encompasses medical management with antibiotics and, when necessary, surgical intervention. The management approach requires a multidisciplinary "Endocarditis Team." This review underscores the need for continued research to refine risk prediction, enhance diagnostic accuracy, and optimize management strategies for TAVR-IE, considering the evolving landscape of transcatheter interventions.
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Affiliation(s)
- Taha Hatab
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Syed Zaid
- Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, TX, USA
| | - Samarthkumar J Thakkar
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Rody G Bou Chaaya
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Michael J Reardon
- Division of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA.
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