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1. HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort

Author

Abbate, A, Chambers, ST, Murdoch, D, Morris, A, Holland, D, Pappas, P, Almela, M, Fernandez-Hidalgo, N, Almirante, B, Bouza, E, Forno, D, del Rio, A, Hannan, MM, Harkness, J, Kanafani, ZA, Lalani, T, Lang, S, Raymond, N, Read, K, Vinogradova, T, Woods, CW, Wray, D, Corey, GR, Chu, VH, Clara, L, Sanchez, M, Nacinovich, F, Fernandez Oses, P, Ronderos, R, Sucari, A, Thierer, J, Casabe, J, Cortes, C, Altclas, J, Kogan, S, Spelman, D, Athan, E, Harris, O, Kennedy, K, Tan, R, Gordon, D, Papanicolas, L, Eisen, D, Grigg, L, Street, A, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, Passos de Brito, AC, Guimaraes, AC, Grinberg, M, Mansur, AJ, Siciliano, RF, Varejao Strabelli, TM, Campos Vieira, ML, de Medeiros Tranchesi, RA, Paiva, MG, Fortes, CQ, Ramos, ADO, Ferraiuoli, G, Golebiovski, W, Lamas, C, Santos, M, Weksler, C, Karlowsky, JA, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Barsic, B, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, El Kholy, A, Mishaal, M, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, C, Doco-Lecompte, T, Selton-Suty, C, Casalta, J-P, Fournier, P-E, Habib, G, Raoult, D, Thuny, F, Delahaye, F, Delahaye, A, Vandenesch, F, Donal, E, Donnio, PY, Michelet, C, Revest, M, Tattevin, P, Violette, J, Chevalier, F, Jeu, A, Dan, Rusinaru, Sorel, C, Tribouilloy, C, Bernard, Y, Chirouze, C, Hoen, B, Leroy, J, Plesiat, P, Naber, C, Neuerburg, C, Mazaheri, B, Athanasia, S, Giannitsioti, E, Mylona, E, Paniara, O, Papanicolaou, K, Pyros, J, Skoutelis, A, Sharma, G, Francis, J, Nair, L, Thomas, V, Venugopal, K, Hannan, M, Hurley, J, Gilon, D, Israel, S, Korem, M, Strahilevitz, J, Tripodi, MF, Casillo, R, Cuccurullo, S, Dialetto, G, Durante-Mangoni, E, Irene, M, Ragone, E, Utili, R, Cecchi, E, De Rosa, F, Imazio, M, Trinchero, R, Tebini, A, Grossi, P, Lattanzio, M, Toniolo, A, Goglio, A, Raglio, A, Ravasio, V, Rizzi, M, Suter, F, Carosi, G, Magri, S, Signorini, L, Baban, T, Kanafani, Z, Kanj, SS, Sfeir, J, Yasmine, M, Abidin, I, Tamin, SS, Martinez, ER, Nieto, GIS, van der Meer, JTM, Chambers, S, Murdoch, DR, Dragulescu, S, Ionac, A, Mornos, C, Butkevich, OM, Chipigina, N, Kirill, O, Vadim, K, Edathodu, J, Halim, M, Lum, L-N, Tan, R-S, Lejko-Zupanc, T, Logar, M, Mueller-Premru, M, Commerford, P, Commerford, A, Deetlefs, E, Hansa, C, Ntsekhe, M, Armero, Y, Azqueta, M, Castaneda, X, Cervera, C, Falces, C, Garcia-de-la-Maria, C, Fita, G, Gatell, JM, Marco, F, Mestres, CA, Miro, JM, Moreno, A, Ninot, S, Pare, C, Pericas, J, Ramirez, J, Rovira, I, Sitges, M, Anguera, I, Font, B, Guma, JR, Bermejo, J, Garcia Fernandez, MA, Gonzalez-Ramallo, V, Marin, M, Munoz, P, Pedromingo, M, Roda, J, Rodriguez-Creixems, M, Solis, J, Tornos, P, de Alarcon, A, Parra, R, Alestig, E, Johansson, M, Olaison, L, Snygg-Martin, U, Pachirat, O, Pachirat, P, Pussadhamma, B, Senthong, V, Casey, A, Elliott, T, Lambert, P, Watkin, R, Eyton, C, Klein, JL, Bradley, S, Kauffman, C, Bedimo, R, Crowley, AL, Douglas, P, Drew, L, Fowler, VG, Holland, T, Mudrick, D, Samad, Z, Sexton, D, Stryjewski, M, Wang, A, Lerakis, S, Cantey, R, Steed, L, Dickerman, SA, Bonilla, H, DiPersio, J, Salstrom, S-J, Baddley, J, Patel, M, Peterson, G, Stancoven, A, Afonso, L, Kulman, T, Levine, D, Rybak, M, Cabell, CH, Baloch, K, Dixon, CC, Harding, T, Jones-Richmond, M, Park, LP, Redick, T, Stafford, J, Anstrom, K, Bayer, AS, Karchmer, AW, Sexton, DJ, Chu, V, Durack, DT, Phil, D, Eykyn, S, Moreillon, P, Abbate, A, Chambers, ST, Murdoch, D, Morris, A, Holland, D, Pappas, P, Almela, M, Fernandez-Hidalgo, N, Almirante, B, Bouza, E, Forno, D, del Rio, A, Hannan, MM, Harkness, J, Kanafani, ZA, Lalani, T, Lang, S, Raymond, N, Read, K, Vinogradova, T, Woods, CW, Wray, D, Corey, GR, Chu, VH, Clara, L, Sanchez, M, Nacinovich, F, Fernandez Oses, P, Ronderos, R, Sucari, A, Thierer, J, Casabe, J, Cortes, C, Altclas, J, Kogan, S, Spelman, D, Athan, E, Harris, O, Kennedy, K, Tan, R, Gordon, D, Papanicolas, L, Eisen, D, Grigg, L, Street, A, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, Passos de Brito, AC, Guimaraes, AC, Grinberg, M, Mansur, AJ, Siciliano, RF, Varejao Strabelli, TM, Campos Vieira, ML, de Medeiros Tranchesi, RA, Paiva, MG, Fortes, CQ, Ramos, ADO, Ferraiuoli, G, Golebiovski, W, Lamas, C, Santos, M, Weksler, C, Karlowsky, JA, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Barsic, B, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, El Kholy, A, Mishaal, M, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, C, Doco-Lecompte, T, Selton-Suty, C, Casalta, J-P, Fournier, P-E, Habib, G, Raoult, D, Thuny, F, Delahaye, F, Delahaye, A, Vandenesch, F, Donal, E, Donnio, PY, Michelet, C, Revest, M, Tattevin, P, Violette, J, Chevalier, F, Jeu, A, Dan, Rusinaru, Sorel, C, Tribouilloy, C, Bernard, Y, Chirouze, C, Hoen, B, Leroy, J, Plesiat, P, Naber, C, Neuerburg, C, Mazaheri, B, Athanasia, S, Giannitsioti, E, Mylona, E, Paniara, O, Papanicolaou, K, Pyros, J, Skoutelis, A, Sharma, G, Francis, J, Nair, L, Thomas, V, Venugopal, K, Hannan, M, Hurley, J, Gilon, D, Israel, S, Korem, M, Strahilevitz, J, Tripodi, MF, Casillo, R, Cuccurullo, S, Dialetto, G, Durante-Mangoni, E, Irene, M, Ragone, E, Utili, R, Cecchi, E, De Rosa, F, Imazio, M, Trinchero, R, Tebini, A, Grossi, P, Lattanzio, M, Toniolo, A, Goglio, A, Raglio, A, Ravasio, V, Rizzi, M, Suter, F, Carosi, G, Magri, S, Signorini, L, Baban, T, Kanafani, Z, Kanj, SS, Sfeir, J, Yasmine, M, Abidin, I, Tamin, SS, Martinez, ER, Nieto, GIS, van der Meer, JTM, Chambers, S, Murdoch, DR, Dragulescu, S, Ionac, A, Mornos, C, Butkevich, OM, Chipigina, N, Kirill, O, Vadim, K, Edathodu, J, Halim, M, Lum, L-N, Tan, R-S, Lejko-Zupanc, T, Logar, M, Mueller-Premru, M, Commerford, P, Commerford, A, Deetlefs, E, Hansa, C, Ntsekhe, M, Armero, Y, Azqueta, M, Castaneda, X, Cervera, C, Falces, C, Garcia-de-la-Maria, C, Fita, G, Gatell, JM, Marco, F, Mestres, CA, Miro, JM, Moreno, A, Ninot, S, Pare, C, Pericas, J, Ramirez, J, Rovira, I, Sitges, M, Anguera, I, Font, B, Guma, JR, Bermejo, J, Garcia Fernandez, MA, Gonzalez-Ramallo, V, Marin, M, Munoz, P, Pedromingo, M, Roda, J, Rodriguez-Creixems, M, Solis, J, Tornos, P, de Alarcon, A, Parra, R, Alestig, E, Johansson, M, Olaison, L, Snygg-Martin, U, Pachirat, O, Pachirat, P, Pussadhamma, B, Senthong, V, Casey, A, Elliott, T, Lambert, P, Watkin, R, Eyton, C, Klein, JL, Bradley, S, Kauffman, C, Bedimo, R, Crowley, AL, Douglas, P, Drew, L, Fowler, VG, Holland, T, Mudrick, D, Samad, Z, Sexton, D, Stryjewski, M, Wang, A, Lerakis, S, Cantey, R, Steed, L, Dickerman, SA, Bonilla, H, DiPersio, J, Salstrom, S-J, Baddley, J, Patel, M, Peterson, G, Stancoven, A, Afonso, L, Kulman, T, Levine, D, Rybak, M, Cabell, CH, Baloch, K, Dixon, CC, Harding, T, Jones-Richmond, M, Park, LP, Redick, T, Stafford, J, Anstrom, K, Bayer, AS, Karchmer, AW, Sexton, DJ, Chu, V, Durack, DT, Phil, D, Eykyn, S, and Moreillon, P

Abstract

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

Published
2013

2. QT prolongation and Torsades de Pointes in patients infected with human immunodeficiency virus and treated with methadone.

Author

Gil M, Sala M, Anguera I, Chapinal O, Cervantes M, Guma JR, Segura F, Gil, Merce, Sala, Montserrat, Anguera, Ignasi, Chapinal, Olga, Cervantes, Manuel, Guma, Joan R, and Segura, Ferran

Abstract

Four patients infected with human immunodeficiency virus receiving antiretroviral treatment and high doses of methadone (>200 mg/day) presented with several syncopal episodes. A significant prolongation of the QTc interval was detected in all of them, and in 3 patients, > or =1 episode of Torsades de Pointes was recorded. The sequence of events in these cases suggests that high doses of methadone caused QT prolongation and provided the substrate for syncope and Torsades de Pointes. [ABSTRACT FROM AUTHOR]

Published
2003
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3. Myocardial metastases presenting as ventricular tachycardia.

Author

Ibars S, Anguera I, Gusi G, Guillaumet E, López L, Guma JR, and Martínez-Rubio A

Subjects
Diagnosis, Differential, Electrocardiography, False Positive Reactions, Humans, Male, Middle Aged, Tonsillar Neoplasms diagnosis, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell secondary, Heart Neoplasms diagnosis, Tachycardia, Ventricular diagnosis
Published
2007
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4. Periannular complications in infective endocarditis involving prosthetic aortic valves.

Author

Anguera I, Miro JM, San Roman JA, de Alarcon A, Anguita M, Almirante B, Evangelista A, Cabell CH, Vilacosta I, Ripoll T, Muñoz P, Navas E, Gonzalez-Juanatey C, Sarria C, Garcia-Bolao I, Fariñas MC, Rufi G, Miralles F, Pare C, Fowler VG Jr, Mestres CA, de Lazzari E, Guma JR, del Río A, and Corey GR

Subjects
Abscess epidemiology, Abscess etiology, Abscess therapy, Adult, Aged, Anti-Infective Agents therapeutic use, Aortic Valve diagnostic imaging, Aortic Valve microbiology, Aortic Valve surgery, Confounding Factors, Epidemiologic, Echocardiography, Endocarditis, Bacterial epidemiology, Endocarditis, Bacterial therapy, Female, Follow-Up Studies, Heart Valve Diseases epidemiology, Heart Valve Diseases microbiology, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications mortality, Prognosis, Prosthesis-Related Infections epidemiology, Prosthesis-Related Infections microbiology, Prosthesis-Related Infections therapy, Reoperation, Retrospective Studies, Risk Factors, Spain epidemiology, Survival Rate, Time Factors, Treatment Outcome, United States epidemiology, Vascular Fistula epidemiology, Vascular Fistula etiology, Vascular Fistula therapy, Endocarditis, Bacterial etiology, Prosthesis-Related Infections complications
Abstract

The periannular extension of infection in prosthetic valve endocarditis (PVE) is a serious complication of infective endocarditis associated with high mortality. Periannular lesions in PVE occasionally rupture into adjacent cardiac chambers, leading to aortocavitary fistulae and intracardiac shunting. It is unknown whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinctive clinical characteristics of patients with PVE and either aortocavitary fistulization or nonruptured abscesses. In a retrospective multicenter study of >872 PVE episodes, 150 patients (17%) with periannular complications in PVE in the aortic position were identified (29 with aortocavitary fistulization and 121 with nonruptured abscesses). Early-onset PVE was present in 73 patients (49%). Rates of heart failure (p = 0.09), ventricular septal defect (p <0.01), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 128 patients (83%). In-hospital mortality in the overall population was 39%. Multivariate analysis identified heart failure (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6 to 6.8), renal failure (OR 2.5, 95% CI 1.2 to 5.2), and co-morbidity (OR 2.4, 95% CI 1.1 to 5.1) as independent risk factors for death. Fistulous tract formation was not associated with increased in-hospital mortality (OR 1.6, 95% CI 0.7 to 3.7). The actuarial 5-year survival rate in surgical survivors was 100% in patients with fistulae and 78% in patients with nonruptured abscesses (log-rank p = 0.14). In conclusion, aortocavitary fistulous tract formation in PVE complicated with periannular complications is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Despite the frequent complications, fistulous tract formation in the current era of infective endocarditis is not an independent risk factor for mortality.

Published
2006
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5. Periannular complications in infective endocarditis involving native aortic valves.

Author

Anguera I, Miro JM, Evangelista A, Cabell CH, San Roman JA, Vilacosta I, Almirante B, Ripoll T, Fariñas MC, Anguita M, Navas E, Gonzalez-Juanatey C, Garcia-Bolao I, Muñoz P, de Alarcon A, Sarria C, Rufi G, Miralles F, Pare C, Fowler VG Jr, Mestres CA, de Lazzari E, Guma JR, Moreno A, and Corey GR

Subjects
Abscess epidemiology, Abscess microbiology, Abscess therapy, Adult, Aged, Analysis of Variance, Anti-Infective Agents therapeutic use, Aortic Valve surgery, Echocardiography, Endocarditis, Bacterial epidemiology, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial therapy, Female, Follow-Up Studies, Heart Valve Diseases epidemiology, Heart Valve Diseases therapy, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prognosis, Retrospective Studies, Risk Factors, Spain epidemiology, Treatment Outcome, United States epidemiology, Vascular Fistula epidemiology, Vascular Fistula microbiology, Vascular Fistula therapy, Aortic Valve microbiology, Endocarditis, Bacterial complications, Heart Valve Diseases microbiology
Abstract

The extension of infection in native valve infective endocarditis (IE) from valvular structures to the periannular tissue is incompletely understood. It is unknown, for example, whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinct clinical characteristics of patients with aortocavitary fistulae and nonruptured abscesses in native valve IE and to evaluate the impact of fistulization on the outcomes of patients with native aortic valve IE complicated with periannular lesions. In a retrospective multicenter study of 2,055 native valve IE episodes, 201 patients (9.8%) with periannular complications in aortic valve IE were identified (46 with aortocavitary fistulization and 155 with nonruptured abscesses). Rates of heart failure (p = 0.07), ventricular septal defect (p <0.001), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 172 patients (86%), and in-hospital mortality in the overall population was 29%. Multivariate analysis identified age >60 years (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3 to 5.2), renal failure (OR 3.0, 95% CI 1.5 to 6.0), and moderate or severe heart failure (OR 2.5, 95% CI 1.2 to 5.2) as independent risk factors for death. There was a trend toward increased in-hospital mortality in patients with aortocavitary fistulae (OR 1.5, 95% CI 0.7 to 3.0). The actuarial 5-year survival rate in surgical survivors was 80% in patients with fistulae and 92% in patients with nonruptured abscesses (log-rank p = 0.6). In conclusion, aortocavitary fistulous tract formation in the setting of native valve IE is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscess. Despite these higher rates of complications, fistulous tract formation in the current era of IE is not an independent risk factor for mortality.

Published
2006
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6. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality.

Author

Anguera I, Miro JM, Vilacosta I, Almirante B, Anguita M, Muñoz P, San Roman JA, de Alarcon A, Ripoll T, Navas E, Gonzalez-Juanatey C, Cabell CH, Sarria C, Garcia-Bolao I, Fariñas MC, Leta R, Rufi G, Miralles F, Pare C, Evangelista A, Fowler VG Jr, Mestres CA, de Lazzari E, and Guma JR

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Aortic Diseases diagnostic imaging, Aortic Diseases mortality, Echocardiography methods, Endocarditis, Bacterial complications, Endocarditis, Bacterial diagnostic imaging, Endocarditis, Bacterial mortality, Female, Heart Diseases diagnostic imaging, Hospital Mortality, Humans, Male, Middle Aged, Mycoses mortality, Retrospective Studies, Risk Factors, Staphylococcal Infections mortality, Streptococcal Infections mortality, Vascular Fistula diagnostic imaging, Aortic Diseases complications, Aortic Valve, Heart Diseases complications, Sinus of Valsalva, Vascular Fistula complications
Abstract

Aims: To investigate the clinical features, echocardiographic characteristics, management, and prognostic factors of mortality of aorto-cavitary fistulization (ACF) in infective endocarditis (IE). Extension of infection in aortic valve IE beyond valvular structures may result in peri-annular complications with resulting necrosis and rupture, and subsequent development of ACF. Aorto-cavitary communications create intra-cardiac shunts, which may result in further clinical deterioration and haemodynamic instability., Methods and Results: In a retrospective multi-centre study over 4681 episodes of IE, a total of 76 patients with ACF [1.6%, confidence interval (CI) 95%: 1.2-2.0%] diagnosed by echocardiography or during surgery were identified. Fistulae were found in 1.8% of cases of native valve IE and in 3.5% of cases of prosthetic valve IE from the general population and in 0.4% of drug abusers. PVE was present in 31 (41%) cases of ACF. Transthoracic and transoesophageal echocardiography detected the fistulous tracts in 53 and 97% of cases, respectively. Peri-annular abscesses were detected in 78% of cases, fistulae originated in similar rates from the three sinuses of Valsalva, and the four cardiac chambers were equally involved in the fistulous tracts. Heart failure (HF) developed in 62% of cases and surgery was performed in 66 (87% CI 95% 77-93%) patients with a mortality of 41% (95% CI 30-53%) in the overall population. Multivariate analysis identified HF (OR 3.4, CI 95% 1.0-11.5), prosthetic IE (OR 4.6, CI 95% 1.4-15.4) and urgent or emergency surgical treatment (OR 4.3, CI 95% 1.3-16.6) as variables significantly associated with an increased risk of death. Major complications during follow-up (death, re-operation, or re-admission for HF) among the five operative survivors with residual fistulae occurred in 20 and 100% of patients at 1 and 2 years, respectively., Conclusion: Aorto-cavitary fistulous tract formation is an uncommon but extremely serious complication of IE. In-hospital mortality was exceptionally high despite aggressive management with surgical intervention in the majority of patients. Prosthetic IE, urgent surgery, and the development of HF identify the subgroup of patients with IE and ACF that have significantly increased risk of in-hospital death.

Published
2005
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