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Aims To determine the prognosis of patients treated for infective endocarditis (IE) according to their healthcare pathway. To assess how the ESC guidelines are implemented concerning the performance of transoesophageal echocardiography, the use of antibiotic therapy, and the performance of valve surgery; and to compare the epidemiological profile of IE according to the type of centres in which the patients are hospitalized. Methods and results In a prospective multicentric study including 22 hospitals in the South-East of France, 342 patients were classified into three groups according to their healthcare pathway: 119 patients diagnosed and taken care entirely in a reference centre or hospital with cardiac surgery [Referral Center (RC) group], 111 patients diagnosed and initially taken care in a non-RC (NRC), then referred in a centre including cardiac surgery [transferred to the Referral Center (TRC) group] and 112 patients totally taken care in the NRC (NRC group). One-year mortality was 26% (88 deaths) and was not significantly different between Groups 1 and 2 (20 vs. 21%, P = 0.83). Patients in the NRC group had a higher mortality (37%) compared with patients in the RC and TRC groups (P Conclusion Prognosis of patients with IE is influenced by their healthcare pathway. Patients treated exclusively in NRC have a worse prognosis than patients treated in referral or surgical centres.

International audience; Mitral valve prolapse (MVP) is a common valvular heart defect with variable outcomes. Several studies reported MVP as an underestimated cause of life-threatening arrhythmias and sudden cardiac death (SCD), mostly in young adult women. Herein, we report a clinical and genetic investigation of a family with bileaflet MVP and a history of syncopes and resuscitated sudden cardiac death. Using family based whole exome sequencing, we identified two missense variants in the SCN5A gene. A rare variant SCN5A:p.Ala572Asp and the well-known functional SCN5A:p.His558Arg polymorphism. Both variants are shared between the mother and her daughter with a history of resuscitated SCD and syncopes, respectively. The second daughter with prodromal MVP as well as her healthy father and sister carried only the SCN5A:p.His558Arg polymorphism. Our study is highly suggestive of the contribution of SCN5A mutations as the potential genetic cause of the electric instability leading to ventricular arrhythmias in familial MVP cases with syncope and/or SCD history.

Summary Background Infective endocarditis (IE) is associated with a high mortality rate, related in part to neurological complications. Studies suggest that valvular surgery should be performed early when indicated, but is often delayed by the presence of neurological complications. Aim To assess the effect of delaying surgery in patients with IE and neurological complications and to identify factors predictive of death. Methods In a prospective, single-centre study in a referral centre for IE, all patients with IE underwent systematic screening for neurological complications. The primary outcome was 6-month death. In patients presenting with neurological complications, the prognosis according to surgical status was analysed and a Cox regression model used to identify variables predictive of death. Results Between April 2014 and January 2018, 351 patients with a definite diagnosis of left-sided IE were included. Ninety-four patients (26.8%) presented with at least one neurological complication. Fifty-nine patients (17.7%) died during 6-month follow-up. Six-month mortality rates did not differ significantly between patients with and without neurological complications (P = 0.60). Forty patients had a temporary surgical contraindication because of neurological complications. During the period of surgical contraindication, seven of these patients (17.5%) died, six (15.0%) presented a new embolic event, and 12 (30.0%) presented cardiac or septic deterioration. In multivariable analysis, predictive factors of death in patients presenting with neurological complications were temporary surgical contraindication (hazard ratio 7.36, 95% confidence interval 1.61–33.67; P = 0.010) and presence of a mechanical prosthetic valve (hazard ratio 16.40, 95% confidence interval 2.22–121.17; P = 0.006). Conclusions Patients with a temporary surgical contraindication due to neurological complications had a higher risk of death and frequent major complications while waiting for surgery. When indicated, the decision to postpone surgery in the early phase should be weighed against the risk of infectious or cardiac deterioration.

International audience; Background: Few data exist concerning genotype-phenotype relationships in left ventricular noncompaction (LVNC).Methods and results: From a multicenter French Registry, we report the genetic and clinical spectrum of 95 patients with LVNC, and their genotype-phenotype relationship. Among the 95 LVNC, 45 had at least 1 mutation, including 14 cases of mutation in ion channel genes. In a complementary analysis including 16 additional patients with ion channel gene mutations, for a total of 30 patients with ion channel gene mutation, we found that those patients had higher median LV ejection fraction (60% vs 40%; P < .001) and more biventricular noncompaction (53.1% vs 18.5%; P < .001) than the 81 other patients with LVNC. Among them, both the 19 patients with an HCN4 mutation and the 11 patients with an RYR2 mutation presented with a higher LV ejection fraction and more frequent biventricular noncompaction than the 81 patients with LVNC but with no mutation in the ion channel gene, but only patients with HCN4 mutation presented with a lower heart rate.Conclusions: Ion channel gene mutations should be searched systematically in patients with LVNC associated with either bradycardia or biventricular noncompaction, particularly when LV systolic function is preserved. Identifying causative mutations is of utmost importance for genetic counselling of at-risk relatives of patients affected by LVNC.

International audience; Background: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been added as a major criterion in the European Society of Cardiology (ESC) 2015 infective endocarditis guidelines. PET/CT is currently used in patients with suspected prosthetic valve and cardiac device-related endocarditis. However, the value of the ESC classification and the clinical impact of PET findings are unknown in patients with native valve endocarditis (NVE).Aims: Our aims were: to assess the value of the ESC criteria (including PET/CT) in NVE; to determine the usefulness of PET/CT concerning embolic detection; and to describe a new PET/CT feature (diffuse splenic uptake).Methods: Between 2012 and 2017, 75 patients with suspected NVE were included prospectively, after exclusion of patients with uninterpretable or unfeasible PET/CT. Using gold standard expert consensus, 63 cases of infective endocarditis were confirmed and 12 were rejected.Results: Significant valvular uptake was observed in 11 of 63 patients with definite NVE and in no patients who had the diagnosis of infective endocarditis rejected (sensitivity 17.5%, specificity 100%). Among the 63 patients with NVE, a peripheral embolism or mycotic aneurysm was observed in 20 (31.7%) cases. Application of the ESC criteria increased Duke criteria sensitivity from 63.5% to 69.8% (P

Summary Background The incremental prognostic value of left atrial (LA) dysfunction, emerging in various clinical contexts, remains poorly explored in hypertrophic cardiomyopathy (HCM). Objective To assess LA strain correlation with outcome in HCM. Methods A cohort of all 307 consecutive patients presenting with HCM between 2007 and 2017 (54 ± 17 years; 34% women), with comprehensive echocardiography at diagnosis and LA peak longitudinal strain (PALS) and LA peak contraction strain (PACS) measurement, was enrolled and occurrence of HCM related cardiac events analysed. Results Clinically, atrial fibrillation (AF) was present in 13%, New York Heart Association functional class II–III in 54%, and B-type natriuretic peptide (BNP) concentration was 199 ± 278 pg/mL. By echocardiography, left ventricular (LV) ejection fraction (EF) was 67 ± 10%, LV thickness 21 ± 5 mm and European Society of Cardiology HCM risk score 3 ± 3%, with 109 patients (36%) presenting obstructive HCM (LV outflow gradient 21 ± 32 mmHg). LA diameter was 41 ± 8 mm [with 109 (36%) presenting LA diameter ≥ 40 mm], LA volume index 50 ± 26 mL/m2, PALS 24 ± 13%, PACS 11 ± 7% and LA peak systolic strain rate (LASRs) 1.7 ± 0.6 s−1. In addition to AF, age, BNP, LVEF and LV thickness were all independent determinants of lower PALS, with odd ratios almost unchanged after adjustment (all P ≤ 0.0004). At a mean follow-up of 21 (range 18–23) months, patients with adverse cardiac events (n = 65) presented with more impaired LA function (all P ≤ 0.0005), with a significant association between impaired PALS and worse outcome, hazard ratio 0.94 [95% confidence interval (CI) 0.92–0.97, P Conclusions The present study, by gathering a unique HCM cohort, suggests a strong link between LA dysfunction and poor outcome, to be further investigated.

Few data exist concerning genotype-phenotype relationships in left ventricular noncompaction (LVNC).From a multicenter French Registry, we report the genetic and clinical spectrum of 95 patients with LVNC, and their genotype-phenotype relationship. Among the 95 LVNC, 45 had at least 1 mutation, including 14 cases of mutation in ion channel genes. In a complementary analysis including 16 additional patients with ion channel gene mutations, for a total of 30 patients with ion channel gene mutation, we found that those patients had higher median LV ejection fraction (60% vs 40%; P.001) and more biventricular noncompaction (53.1% vs 18.5%; P.001) than the 81 other patients with LVNC. Among them, both the 19 patients with an HCN4 mutation and the 11 patients with an RYR2 mutation presented with a higher LV ejection fraction and more frequent biventricular noncompaction than the 81 patients with LVNC but with no mutation in the ion channel gene, but only patients with HCN4 mutation presented with a lower heart rate.Ion channel gene mutations should be searched systematically in patients with LVNC associated with either bradycardia or biventricular noncompaction, particularly when LV systolic function is preserved. Identifying causative mutations is of utmost importance for genetic counselling of at-risk relatives of patients affected by LVNC.

Platelets have largely demonstrated their implication in anti-infectious immunity. This effect is ensured by the secreted molecules stored mostly in platelet alpha granules. Previous studies have reported that

Platelets have largely demonstrated their implication in anti-infectious immunity. This effect is ensured by the secreted molecules stored mostly in platelet alpha granules. Previous studies have r...

ObjectiveThe primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.MethodsProspective case–control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.ResultsPatients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; pStreptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.ConclusionsPS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (TC) +/- rifampicin and gentamicin, with a rapid switch to oral administration of TC.This before-after intervention study compared the outcomes of 170 control patients before introduction of the TC protocol (2001-2011) with the outcomes of 171 patients in the TC group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of TC (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the TC group. The mean duration of hospital stay was significantly shorter in the TC group (30 vs 39 days; P=0.005).The management of S. aureus infective endocarditis using a rapid shift to oral administration of TC reduced the length of hospital stay and the mortality rate.

This study sought to assess the prognostic value ofThis study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an

Neisseria macacae is a Gram-negative diplococcus, found in the oropharynx of healthy Rhesus Monkeys. Infections caused by N. macacae in humans are extremely rare. We present here the first case of N. macacae infective endocarditis in a 65-year-old man with a native aortic valve infection complicated by a peri-aortic abscess. N. macacae was isolated from blood culture and was found on the cardiac valve using 16S rDNA detection. Despite an appropriate antibiotic therapy, and aortic homograft replacement, and mitral repair, the patient died 4 days after surgery from a massive hemorrhagic stroke.

Both stretching and C48/80 have been hypothesized to cause disruption of cell-matrix adhesions and thereby affect the dynamics of fluid balance in tissues. We investigated the effect of sinusoidal stretching and/or C48/80 on the morphology of fibroblasts in skin excised from the backs of Wistar-Möller rats in order to assess how these stimuli affect cellular interactions in tissues. Tissue samples were either soaked in Krebs' buffer with and without C48/80, or sinusoidally stretched (20% strain) in buffer with and without C48/80. Control skin was fixed immediately after excision. All tissues were processed for transmission electron microscopy. Morphometric analyses demonstrated that sinusoidal stretching of the skin results in the retraction or disruption of fibroblast cytoplasmic extensions, rounding up of the cell bodies and subsequently in increased tissue water content. C48/80 had no apparent effect on fibroblast morphology and adherence in tissues.

Twenty-one exopolysaccharide-producing strains were isolated from the 5-20 microns fraction of a vertisol in the south-east of the island of Martinique in the French West Indies. Although these strains were phenotypically identified as Burkholderia cepacia or as Burkholderia glathei using BIOLOG microplates, they did not cluster genotypically by amplified rDNA restriction analysis (ARDRA) with any described Burkholderia species. A phylogenetic analysis revealed that the rrs (16S rDNA) sequences of three representative strains clustered in a single branch within the genus Burkholderia and distantly from all of the previously described species of Burkholderia for which rrs sequences were available. DNA-DNA hybridization data as well as phenotypic analyses indicated that the 21 isolates represented a single and new species for which the name Burkholderia caribensis sp. nov. is proposed (type strain MWAP64T = LMG 18531T).

But de l’étude : évaluation de la technique déformation de l’oreillette gauche (OG) par speckle-tracking dans la stratification rythmique des patients porteurs de cardiomyopathie hypertrophique (CMH). Évaluation des paramètres les plus pertinents à l’élaboration d’un nouveau calculateur de prédiction de mort subite (MS).Protocole : étude de pronostic d’une cohorte de patients porteurs de CMH nouvellement diagnostiquée dans trois centres hôpitalo-universitaires (CHU) français entre 2007 et 2018.Lieu de l’étude : Hôpital La Timone CHU Marseille, Hôpital Pontchaillou CHU Rennes, Hôpital Haut-Lévêque CHU Bordeaux.Malades : 454 patients ont été inclus consécutivement dans les trois centres : 326 au CHU de Marseille, 51 au CHU de Bordeaux, 77 au CHU de Rennes. 23 patients ont été exclus car ils étaient mineurs et le diagnostic de CMH a été infirmé à posteriori. 36 patients (8%) ont été perdus de vue.Intervention : suivi pronostique de ces patients à la lumière de leur critère d’inclusion notamment l’analyse de déformation myocardique par échographie trans thoracique (ETT).Critère de jugement principal : Critère composite incluant la survenue d’une tachycardie ventriculaire (TV), d’une thérapie appropriée délivrée par un défibrillateur automatique implantable (DAI) ou décès toute cause.Résultats : les patients ayant rencontré le critère de jugement principal présentaient une moins bonne fonction de déformation de l’OG HR multivarié 0,95 IC95% [0,92-0,99] ; P 0.023 en analyse multivariée. Le strain du ventricule gauche et l’antécédent de syncope se sont aussi révélés être liés à notre évènement principal en analyse multivariée.Conclusion : cette étude suggère une valeur pronostique additive de la dysfonction de l’OG par speckle-tracking bidimensionnel dans l'évaluation pronostique des patients porteurs de CMH sarcomériques.