bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left-sided native valve infective endocarditis concomitant with severe valvular regurgitation: Prevalence, characteristics and prognostic factors
Authors: Lopez Diaz J , Lozano A , Cabezon G , De Miguel M , Pulido P , Vilacosta I , Olmos C , Saez C , Gomez I , San Roman J A 
Published: November 2023

Abstract

Background
The characteristics of patients with left-sided native valve infective endocarditis and severe valvular regurgitation has never been studied.

Purpose
To analyze the prevalence of severe valvular regurgitation in patients with left-sided infective endocarditis, to describe in detail their characteristics and to determine the prognostic factors of these patients.

Patients and methods
We included in an ongoing multipurpose database, all patients with definite left-sided infective endocarditis admitted in three Spanish tertiary hospitals from 2005 to 2022. We describe the clinical, epidemiological, microbiological, echocardiographic characteristics of patients with severe valvular regurgitation and compared it with those without it. We also analyzed the independent factors of in-hospital mortality of these patients.

Results
Of a total of 874 patients with left-sided native valve infective endocarditis of our series, 564 had severe valvular regurgitation (65%). Comparison between patients with and without severe valvular regurgitation is shown in figure 1. Age (HR 1.035 95% CI 1.02-1.05), S. aureus (HR 2.26; 95% CI 1.26-4.1), vegetations (HR 3.7; 95% CI 1.2-11.4), heart failure (HR 2.76; 95% IC 1.5-5.1), renal failure (HR 3.1; 95% CI 1.9-4.9) and septic shock (HR 4.3; 95% CI 2.29-8) were the independent factors of in hospital mortality. On the contrary, cardiac surgery is an independent protector factor of mortality (HR 0.35; 95% CI 0.21-0.59).

Conclusions
A very high proportion of patients with definite left-sided infective endocarditis have severe valvular regurgitation in our series. Despite important epidemiological, clinical and echocardiographic differences with patients without it, the short-term prognosis is similar Surgery is an independent protective factor in these patients.
Mitral valve replacement versus repair and long-term risk of infective endocarditis: a nationwide study
Authors: Alhakak A , Butt J H , Havers-Borgersen E , Smerup M H , Kober L , Fosbol E L 
Published: November 2023

Abstract

Background
There is a paucity of data regarding mitral valve (MV) repair versus MV replacement and the associated risk of infective endocarditis (IE). Further research is needed to optimise patient selection and determine the importance of using prophylactic antibiotics.

Purpose
To examine the long-term risk of IE in patients undergoing MV repair, compared with a matched population of patients undergoing MV replacement as well as the background population.

Methods
All patients undergoing MV repair from 2000 to 2020 with no history of IE were identified using Danish nationwide registries. Those patients were matched to patients undergoing MV replacement in a 1:1 ratio as well as the background population in a 1:4 ratio based on age, sex, and year of procedure. The Aalen-Johansen estimator and multivariable Cox regression models were used to examine the long-term risk of IE.

Results
After matching, the study population included 1,797 patients undergoing MV replacement, 1,797 undergoing MV repair, and 7,188 matched controls from the background population. The median age of the study population was 67.8 years (percentile[p]25-p75: 57.8-74.7), and 45.1% were females. Patients with MV replacement were significantly more comorbid, compared with patients with MV repair and the control group, which included ischaemic heart disease, heart failure, atrial fibrillation, stroke, diabetes, chronic renal disease, and chronic obstructive pulmonary disease.
During a median follow-up of 7.7 years (p25-p75: 4.0-13.5), 134 (7.5%) with MV replacement, 57 (3.2%) patients with MV repair, and 27 (0.38%) in the control group were hospitalised with IE.
The median follow-up time from date of procedure to IE admission was 3.5 years (p25-p75: 0.82-7.1) in the MV replacement group, 2.4 years (p25-p75: 0.61-6.6) in the MV repair group, and 8.2 years (p25-p75: 5.3-12.4) in the control group.
In patients with MV replacement, MV repair, and the control group, the 1-year cumulative incidences of IE (Figure) were 7.5% (95% CI: 6.3-8.7%), 3.2% (95% CI: 2.4-4.1%), and 0.38% (95% CI: 0.25-0.54%), respectively.
The 10-year cumulative incidences of IE (Figure) were 9.4% (95% CI: 7.9-11.1%), 3.9% (95% CI: 3.0-5.0%), and 0.56% (95% CI: 0.38-0.82%) in patients with MV replacement, MV repair, and the control group, respectively.
After multivariable adjustment, MV replacement was associated with an increased 10-year rate of IE, compared with MV repair (hazard ratio 2.4 [95% CI: 1.8-3.3]), while the control group was associated with a lower 10-year rate, compared with MV repair (hazard ratio 0.14 [95% CI: 0.085-0.23]).

Conclusion
In this nationwide study, MV replacement was associated with a twofold increased 10-year rate of infective endocarditis, while matched controls from the background population were associated with a significantly lower 10-year rate of infective endocarditis, compared with MV repair.Figure
Role of thoracoabdominal imaging on diagnosis and management in patients with suspected infective endocarditis
Authors: Papadimitriou-Olivgeris M , Guery B , Rotzinger D , Kamani C , Fahrni G , Prior J , Ianculescu N , Auberson D , Tzimas G , Hugelshofer S , Tozzi P , Kirsch M , Monney P 
Published: November 2023

Abstract

Background/Introduction
Embolic events (EEs) are a common complication of infective endocarditis (IE) and their presence can impact diagnosis and modify the therapeutic plan.

Purpose
The present study aimed to describe the role of thoracoabdominal imaging (TA-Im) on diagnosis and management of patients with suspected IE.

Methods
This study was conducted at a university hospital, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria.

Results
Among 966 episodes with IE suspicion and TA-Im, 740 (77%) contrast-enhanced CT, 158 (16%) 18F-FDG PET/CT and 68 (7%) non-contrast-enhanced CT. The majority of patients (528; 55%) were without thoracoabdominal symptoms. At least one EE was found in 205 (21%) episodes. Based on TA-Im findings, the diagnosis was reclassified from rejected to possible or from possible to definite IE in 6 (1%) and 10 (1%) episodes, respectively [2 (0.5%) and 5 (1%) in asymptomatic episodes, respectively]. Table shows the type of embolic events and their impact on diagnosis in episodes with suspected IE. Among the 413 patients with possible or definite IE, at least one EE was found on TA-Im in 143 (35%) episodes. Together with the presence of left-side valvular vegetation &gt;10mm, the results of TA-Im established a surgical indication (prevention of embolism) in 15 (4%) episodes, 7 of which were asymptomatic. Among the subgroup of episodes (n=127) with left-side vegetation &gt;10mm, TA-Im established a surgical indication in 12% of episodes (15 patients), 10% among asymptomatic episodes (7 out of 73). Figure shows the changes in diagnostic classification and management due to TA-Im results in patients suspected (A) and those with IE (B).

Conclusion
TA-Im performed in asymptomatic patients with IE suspicion improved the diagnosis of IE in only a small proportion of patients; this proportion was similarly low in symptomatic patients. The role of systematic TA-Im in the clinical management of asymptomatic IE patients remains unclear, since it identified a new indication for valvular surgery in only a small proportion of patients. The scenario, where the benefit of TA-Im on management is a patient with a vegetation &gt;10mm; in those patients, systematic TA-Im may lead to a new surgical indication in 10% of cases.Embolic eventsDiagnosis and mangement
Does the use of anticoagulation or antiplatelet therapy increase cerebrovascular events in patients with infective endocarditis - a systematic review and meta-analysis
Authors: Caldonazo T , Musleh R , Moschovas A , Kirov H , Witte O , Franz M , Faerber G , Doenst T , Diab M , Guenther A 
Published: November 2023

Abstract

Background
Management of anticoagulant and antiplatelet therapy in patients with infective endocarditis (IE) remains challenging. We aimed to evaluate the impact of antiplatelet and anticoagulant therapy on cerebrovascular events (CVE) and mortality in IE-patients.

Methods
Assessing three databases (MEDLINE, EMBASE, and Cochrane Library), we performed a systematic review and meta-analysis of studies comparing patients with prior and/or ongoing use of antithrombotic therapy (anticoagulation or antiplatelet) versus those without any antithrombotic therapy during IE course. Primary outcome was CVE. Secondary outcomes were perioperative and mid-term (&gt;6 months) mortality, intracranial hemorrhage (ICH), and systemic thromboembolism. Inverse variance method was performed.

Results
Twelve studies with a total of 11,960 patients were included. The primary endpoint (CVE) was not different between the anticoagulation or the antiplatelet group and the control group. Perioperative mortality was lower in the anticoagulation group compared to the control group (OR= 0.74, 0.57-0.96, p=0.03). There was no significant difference in the incidence of ICH between the anticoagulation or antiplatelet group and the control group.

Conclusion
The results suggest that the prior and/or ongoing use of anticoagulants or antiplatelets in patients with IE was associated with similar rates of CVE in general and of ICH in particular. Lack of information about the indications for stopping or continuing antithrombotic therapy in the majority of the included studies is a limitation of this meta-analysis, showing the necessity of a randomized setup.
Blood cardioplegia may be better than crystalloid cardioplegia during cardiac surgery for infective endocarditis
Authors: Caldonazo T , Safarov R , Doenst T , Moschovas A , Kirov H , Kaluza M , Schneider U , Faerber G , Diab M 
Published: November 2023

Abstract

Background
Cardioplegia is an indispensable element in cardiac surgery for left sided infective endocarditis (IE). Crystalloid cardiolegia (CC) as a single or dual-dose is more attractive in complicated IE surgery than repeated, every 15-20 min, administration of blood cardioplegia (BC). Recently, blood cardioplegia was shown to reduce the systemic inflammatory response to cardiopulmonary (CPB) compared to crystalloid cardioplegia. As the systemic inflammatory response after surgery for IE endocarditis is more exaggerated than in non-IE valve surgery, it is important to investigate impact of the two solutions on outcome after IE surgery.

Methods
We retrospectively analyzed data of all patients (n=581) with endocarditis who underwent cardiac valve surgery at our institution between January 2007 and March 2018. The primary endpoint was 30-day mortality, secondary endpointwas the length of intensive care unit (ICU) stay. Nearest neighbor propensity matching with a caliper of 0.01 was performed to adjust for differences in basal characteristics between patients who received Calafiore BC vs Bretschneider CC.

Results
Patients who received CC were older (67 vs 63, p&lt;0.01) had greater incidence of large vegetations (42.7% vs 32.3%, p&lt;0.01), prosthetic valve endocarditis (30.8% vs 17.3%, p&lt;0.01) and mitral valve endocarditis (54.6 vs 43.6 p&lt;0.01). Logistic regression in the raw data revealed a higher mortality rate and longer LOS in ICU for the patients who received CC. After matching, CC was still associated with higher 30-day mortality (24.4% vs 15.9%, p=0.01) and longer ICU-stay (median: 6, IQR: 9 vs median: 3, IQR: 6, p&lt;0.01).

Conclusions
Administration of blood cardioplegia during cardiac surgery for infective endocarditis may be associated with lower 30-day mortality and shorter ICU-stay compared to using crystalloid solution.
Do we need to improve the general oral health of our population to reduce the risk of Infective Endocarditis?
Authors: Davies A D , De Kare-Silver C , Bhamra N B , Mccue M M , Suarez C S , Das S D , Ambekar S A , Bunet A B , Uppal R U , Nanayakkara L N , Woldman S W , Primus C P 
Published: November 2023

Abstract

Background
Emphasis is placed on the link between oral health and Infective Endocarditis (IE), particularly around odontogenic infections and specific dental procedures. The Adult Dental Health Survey in 2009 showed 45% of adults in the UK required dental intervention typically associated with developing IE. Antibiotic prophylaxis in this context is not without controversy. With gum and periodontic disease endemic, is the modern issue one of generalised poor oral health as a risk factor for IE?

Purpose
To determine the impact of oral health on risk and outcome in IE.

Terminology
SDCEP published dental guidelines of when to consider AP against IE for dental procedures. It identifies dental procedures that can cause transient bacteraemia.

Methodology
Data were collected from October 2020-Januaury 2023 in 123 patients with confirmed IE at a central London cardiac surgical centre. Patients had a focussed dental assessment with history, intraoral examination and dental panoramic radiograph to determine the risk and extent of oral disease.

Results
Average age was 54.2years. 77/123 (63%) had native IE (NVE) and 46 (37%) prosthetic (PVE). 17 (37%) cultured oral organisms from blood (Table 1); 8 (47%) of these organisms are associated with active dental disease (decay, periodontal disease, dental infection). Organisms can be found in Table 2.
However, 93/123 (76%) had oral caries requiring dental treatment, irrespective of typical portal of entry for that organism. The proposed dental treatment posed a high risk for causing IE in 70%. 93/123 (76%) needed further dental treatment within six months rendering only 12% of patients orally stable. Oral organisms were seen more frequently in NVE (41/77) vs PVE (17/46). There was no difference in the incidence of dental disease requiring treatment (77% NVE vs 74% PVE). Whilst 27% of PVE had had recent (within 4 months) dental treatment compared to 73% NVE, only 1 PVE patient grew an oral commensal compared to 82% of NVE patients.

Conclusion
Prevention of IE is key to reducing the morbidity and mortality of this disease. We see oral commensals causing IE in 47%, with only 12% of this modern IE cohort dentally stable. Despite this, there was no difference in rates of dental disease requiring invasive treatment when stratified by oral vs non-oral organisms. A robust public health strategy is required to reduce the risk of oral disease driving IE.
Founder effect of a pathogenic TNNT2 variant in the northwest of Spain responsible for a non-severe phenotype of hypertrophic cardiomyopathy
Authors: Valverde M , Peteiro-Deben R P D , Maneiro E M , Garcia-Hernandez S G H , Amor-Salamanca A M S , Cardenas-Reyes I C R , Barriales-Villa R B V , Larranaga-Moreira J M L M , Cabrera Argana D C A , Fernandez Fernandez X F F , Gomez Diaz I G D , Perez Barbeito M P B , Cazon Varela L C V , Ortiz Genga M O G , Ochoa J P O 
Published: November 2023

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, with a prevalence between 1/250-500 individuals. The yield of genetic testing for this condition stands at 40%. The most prevalent genes are MYBPC3 and MYH7, with small contributions of other genes, such as TNNT2, TNNI3, TPM1, MYL2 or FHOD3. At our center, we have identified a recurrent variant in TNNT2, p.Asn271Ile, associated with HCM. Most probands came from the northwest of Spain (Galicia), which suggested that they may share a common origin.

Purpose
We aimed to determine whether carriers of the p.Asn271Ile variant in TNNT2 share a common haplotype, in order to estimate the age of the mutation and describe the associated phenotype.

Methods
We analyzed probands who had TNNT2 sequenced by NGS at our center. Enrichment of the variant was observed in the HCM cohort. Eight highly polymorphic microsatellite markers flanking the variant in 18 Galician HCM probands were also analyzed, compromising a region of approximately 7,300 kb. Custom PCR assays were designed, and fragment length analysis was performed by capillary electrophoresis.

Results
TNNT2 p.Asn271Ile was identified in 49/28,802 probands (0.17%). The variant was significantly enriched in HCM probands (47/11,870; 0.39%) compared to internal non-HCM controls (2/14,804; 0.02%), with an OR=29.3 (IC95%=7.1-120.7). The analysis revealed that the 18 HCM Galician probands shared a common haplotype of 500 kb, estimating that p.Asn271Ile has arisen approximately 26.5 generations ago (650 years).
Regarding genotype-phenotype correlation, our data (more than 180 carriers from 64 families) shows a relatively benign behavior, with an advance mean age at diagnosis [(49.8 (±17.7)], non-severe left ventricular hypertrophy [15.3 (±5.3)], and a lower rate of major events among carriers of p.Asn271Ile in TNNT2, compared to both other genetic variants in TNNT2 and the main genetic cause of HCM (i.e., null variants in MYBPC3) (p=0.0001 for both comparisons). The prevalence of left ventricular systolic dysfunction and left ventricular tract obstruction was also smaller than that described for other sarcomeric genes (3.54% and 12%, respectively).

Conclusions
A founder effect of the pathogenic variant p.Asn271Ile has been demonstrated, with the variant arising approximately 650 years ago. The clinical behavior in carriers of this cohort showed to be relatively benign compared to the behavior of other genetic variants in this gene and null variants in MYBPC3.
Increased troponin I blood level and in-hospital outcome across successive COVID-19 waves
Authors: Benchimol Barbosa P R 
Published: November 2023

Abstract

Introduction
Troponin I blood level (TnI) is often elevated in patients hospitalized due to COVID-19, and high TnI is associated with adverse outcomes, in this scenario. However, the case rate of high TnI in hospitalized patients and respective case fatality rates (CFR) across different COVID-19 waves still demand investigation, as emerging SARS-CoV-2 variants may affect the cardiac tissue diversely. This study investigated the case rate of high TnI and respective in-hospital outcome in patients hospitalized due to COVID-19 during successive pandemic waves.

Methods
In a retrospective observational cohort study, patients hospitalized due to COVID-19 from March 1st 2020 to July 31st 2022 in a reference hospital were analyzed. Inclusion criteria were: positive SARS-CoV-2 RT-PCR, hospitalization in a COVID-19 cohort ward or ICU, and at least one TnI assessed during hospitalization. Patients presenting acute coronary syndromes were excluded. TnI was assessed using electrochemiluminescence technique, and the highest value during hospital stay considered for analysis. TnI was positive (+) if above normality reference level and negative (-), otherwise. Outcome was in-hospital survival. Age on admission, total length-of-stay (TLOS), TnI(+) case rate, and CFR (the rate of non-survivors to COVID-19 admissions) were analyzed. COVID-19 waves were analyzed on 7-day moving average positive cases series (1), and respective onset and offset assessed by change point detection algorithm and visual inspection. In each wave period, dominants circulating variants from surveillance data (2,3) were matched. Discrete variables were described as percentage and analyzed by Chi-squared test. Continuous variables were described as mean ± SD, and compared by Student t or 1-factor ANOVA test as appropriate. Bicaudal 95% confidence interval (CI) was calculated as needed. Alpha error level was set at 0.05.

Results
From March 1st 2020 to July 31st 2022, six COVID-16 waves were identified, and 628 patients met the inclusion criteria. Overall, TnI(+) case rate was 72.0% (95% CI [68.4% - 75.4%]), and CFR was higher among TnI(+) (63.7%) than TnI(-) (32.4%; p &lt; 0.001). As of March 1st 2020, there was a significant trend toward increasing TnI(+) case rate (p trend &lt; 0.001) and decreasing CFR in both TnI(+) (p trend &lt; 0.001) and TnI(-) (p trend &lt; 0.01) across successive COVID-19 waves. Patients with TnI(+) were older (66.1 ± 14.7 years old) and had a longer TLOS (27.8 ± 24.5 days) than with TnI(-) (respectively, 59.0 ± 15.7 years old and 20.6 ± 17.0 days; p &lt; 0.001 for both). TnI(+) case rate, TnI(+)-related and TnI(-)-related CFR, age, and TLOS across COVID-19 waves are in Table 1.

Conclusion
From March 1st 2020 to July 31st 2022, in patients hospitalized due to COVID-19, TnI(+) was associated with increased case fatality rate as compared to TnI(-), across six successive COVID-19 waves. Patients presenting TnI(+) were older and had longer total length-of-stay as compared to TnI(-).Table 1
CMR predictors of favourable outcome in myocarditis: a single-centre experience
Authors: Baritussio A , Simeti G , Ocagli H , Giordani A S , Basso C , Rizzo S , De Gaspari M , Motta R , De Conti G , Perazzolo Marra M , Tarantini G , Iliceto S , Gregori D , Marcolongo R , Caforio A L P 
Published: November 2023

Abstract

Background
Cardiovascular magnetic resonance (CMR) has emerged as the most accurate, non-invasive method to support diagnosis of clinically suspected myocarditis and has proved to risk-stratify patients with both ischemic and non-ischemic cardiomyopathies.

Purpose
We aimed to assess the diagnostic and prognostic role of CMR at diagnosis in patients with clinically suspected or endomyocardial biopsy (EMB) proven myocarditis.

Methods
We enrolled consecutive single-centre patients with EMB-proven or clinically suspected myocarditis (defined in keeping with the World Health Organization and the European Society of Cardiology (ESC) criteria) undergoing CMR at diagnosis. Extent of late gadolinium enhancement (LGE) was quantified with the full width at half maximum method. Pre-specified outcome was defined as NYHA class &gt; I and echocardiographic left ventricular ejection fraction (LVEF) &lt; 50% at follow-up.

Results
We included 207 patients (74% male, median age 36 years; 25% EMB-proven). CMR showed the highest diagnostic sensitivity in myocarditis patients with infarct-like presentation. Myocardial oedema was found in 63% of patients and LGE in 93%, with a more diffuse distribution in EMB-proven myocarditis. Right ventricular LGE was more prevalent among EMB-proven myocarditis (8% vs 0, p&lt;0.001) and in patients with arrhythmic presentation (12% vs 1% in patients with infarct-like or heart failure presentation, p=0.001). Outcome was met in 17 patients at any follow-up time point, more commonly in patients with larger biventricular volumes (end-diastolic left HR 1.02, right HR 1.04, p&lt;0.001), CMR-based diagnosis of dilated cardiomyopathy (HR 40.7, p&lt;0.001) and ischemic LGE (HR 56.4, p=0.005), while higher biventricular function (LVEF HR 0.89, p&lt;0.001) and greater LGE extent (HR 0.73, p=0.033) at diagnosis had a protective effect.

Conclusions
Higher biventricular function and greater LGE extent on CMR at diagnosis predict more favourable outcome in myocarditis; LGE at diagnosis may represent oedema rather than fibrosis.