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6. Validated risk score for predicting 6-month mortality in infective endocarditis

Author

Park, LP, Chu, VH, Peterson, G, Skoutelis, A, Lejko-Zupa, T, Bouza, E, Tattevin, P, Habib, G, Tan, R, Gonzalez, J, Altclas, J, Edathodu, J, Fortes, CQ, Siciliano, RF, Pachirat, O, Kanj, S, Wang, A, Clara, L, LSanchez, M, Casabé, J, Cortes, C, Nacinovich, F, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Spelman, D, Athan, E, Harris, O, Kennedy, K, Gordon, D, Papanicolas, L, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Harkness, J, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, de Brito, ACP, Guimarães, AC, Tranchesi, RADM, Paiva, MG, Ramos, ADO, Weksler, C, Ferraiuoli, G, Golebiovski, W, Lamas, C, James, AK, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Fernandez, R, Franco, L, Jaramillo, AN, Barsic, B, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, Kholy, AE, Mishaal, M, Osama, D, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, CC, Doco-Lecompte, T, Selton-Suty, C, Delahaye, F, Delahaye, A, Vandenesch, F, Park, LP, Chu, VH, Peterson, G, Skoutelis, A, Lejko-Zupa, T, Bouza, E, Tattevin, P, Habib, G, Tan, R, Gonzalez, J, Altclas, J, Edathodu, J, Fortes, CQ, Siciliano, RF, Pachirat, O, Kanj, S, Wang, A, Clara, L, LSanchez, M, Casabé, J, Cortes, C, Nacinovich, F, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Spelman, D, Athan, E, Harris, O, Kennedy, K, Gordon, D, Papanicolas, L, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Harkness, J, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, de Brito, ACP, Guimarães, AC, Tranchesi, RADM, Paiva, MG, Ramos, ADO, Weksler, C, Ferraiuoli, G, Golebiovski, W, Lamas, C, James, AK, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Fernandez, R, Franco, L, Jaramillo, AN, Barsic, B, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, Kholy, AE, Mishaal, M, Osama, D, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, CC, Doco-Lecompte, T, Selton-Suty, C, Delahaye, F, Delahaye, A, and Vandenesch, F

Abstract

Background-Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. Methods and Results-Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions-Six-month mortality after IE is 25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.

Published
2016

7. Impact of early valve surgery on outcome of staphylococcus aureus prosthetic valve infective endocarditis: Analysis in the international collaboration of endocarditis-prospective cohort study.

Author

Vincelj J., Sexton D.J., Corey G.R., Chu V.H., Wang A., Erpelding M.-L., Durante-Mangoni E., Fernandez-Hidalgo N., Giannitsioti E., Hannan M.M., Lejko-Zupanc T., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., 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 J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Holland T., Lalani T., Mudrick D., Samad Z., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Di Persio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Bayer A.S., Karchmer A.W., Durack D.T., Eykyn S., Moreillon P., Chirouze C., Alla F., Fowler V.G., Miro J.M., Munoz P., Murdoch D.R., Tattevin P., Tribouilloy C., Hoen B., Clara L., Sanchez M., Nacinovich F., Oses P.F., 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., Konecny P., Lawrence R., Rees D., Ryan S., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., De Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Freiberger T., Pol J., Zaloudikova B., Zainab A., El Kholy A., Mishaal M., Rizk H., Aissa N., Alauzet C., 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 P.Y., Michelet C., Revest M., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Bernard Y., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Athanasia S., Deliolanis I., Giamarellou H., Tsaganos T., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Sharma G., Francis J., Nair L., Thomas V., Venugopal K., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Casillo R., Cuccurullo S., Dialetto G., Irene M., Ragone E., Tripodi M.F., Utili R., Cecchi E., De Rosa F., Forno D., 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 S.S., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Lum L.-N., Tan R.-S., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Garcia-De-La-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Moreno A., Ninot S., Vincelj J., Sexton D.J., Corey G.R., Chu V.H., Wang A., Erpelding M.-L., Durante-Mangoni E., Fernandez-Hidalgo N., Giannitsioti E., Hannan M.M., Lejko-Zupanc T., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., 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 J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Holland T., Lalani T., Mudrick D., Samad Z., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Di Persio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Bayer A.S., Karchmer A.W., Durack D.T., Eykyn S., Moreillon P., Chirouze C., Alla F., Fowler V.G., Miro J.M., Munoz P., Murdoch D.R., Tattevin P., Tribouilloy C., Hoen B., Clara L., Sanchez M., Nacinovich F., Oses P.F., 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., Konecny P., Lawrence R., Rees D., Ryan S., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., De Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Freiberger T., Pol J., Zaloudikova B., Zainab A., El Kholy A., Mishaal M., Rizk H., Aissa N., Alauzet C., 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 P.Y., Michelet C., Revest M., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Bernard Y., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Athanasia S., Deliolanis I., Giamarellou H., Tsaganos T., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Sharma G., Francis J., Nair L., Thomas V., Venugopal K., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Casillo R., Cuccurullo S., Dialetto G., Irene M., Ragone E., Tripodi M.F., Utili R., Cecchi E., De Rosa F., Forno D., 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 S.S., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Lum L.-N., Tan R.-S., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Garcia-De-La-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Moreno A., and Ninot S.

Abstract

Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.Copyright © The Author 2014.

Published
2015

8. Candida infective endocarditis: An observational cohort study with a focus on therapy.

Author

Campagnac C., Llopis J., Marco F., Mestres C.A., Moreno A., Ninot S., Pare C., Pericas J.M., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Leoni M.E.G., Robles J.A.G., Ramallo V.G., Cruz A.F., Kestler M., Marin M., Selles M.M., Abella H.R., Roda J.R., Lopez R.A., Pinilla B., Pinto A., Valerio M., Vazquez P., Verde E., Almirante B., 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 J.L., Kauffman C., Bedimo R., Corey G.R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Wang A., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., DiPersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Levine D., Riddle J., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Park L.P., Sanderford B., Stafford J., Anstrom K., Karchmer A.W., Sexton D.J., Durack D.T., Eykyn S., Moreillon P., Sexton. D.J., Arnold C.J., Johnson M., Bayer A.S., Bradley S., Giannitsioti E., Miro J.M., Tornos P., Tattevin P., Strahilevitz J., Spelman D., Athan E., Nacinovich F., Lamas C., Barsic B., Fernandez-Hidalgo N., Munoz P., Chu V.H., Clara L., Sanchez M., Casabe J., Cortes C., Oses P.F., Ronderos R., Sucari A., Thierer J., Altclas J., Kogan S., Harris O., Kennedy K., Tan R., Gordon D., Papanicolas L., Korman T., Kotsanas D., Dever R., Jones P., Konecny P., Lawrence R., Rees D., Ryan S., Feneley M.P., Harkness J., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., De Oliveira Ramos A., Weksler C., Ferraiuoli G., Golebiovski W., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Fernandez R., Franco L., Gonzalez J., Jaramillo A.N., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Vincelj J., Freiberger T., Pol J., Zaloudikova B., Ashour Z., Kholy A.E., Mishaal M., Osama D., Rizk H., Aissa N., Alauzet C., Alla F., 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 P.Y., Flecher E., Michelet C., Revest M., Chevalier F., Jeu A., Remadi J.P., Rusinaru D., Tribouilloy C., Bernard Y., Chirouze C., Hoen B., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Helen G., Sofia A., Ioannis D., Thomas T., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Sharma G., Francis J., Nair L., Thomas V., Venugopal K., Hannan M.M., Hurley J.P., Cahan A., Gilon D., Israel S., Korem M., Durante-Mangoni E., Mattucci I., Pinto D., Agrusta F., Senese A., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., Imazio M., Trinchero R., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Carosi G., Magri S., Signorini L., Kanafani Z., Kanj S.S., Sharif-Yakan A., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Murdoch D.R., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Liew Y.-Y., Tan R.-S., Lejko-Zupanc T., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Falces C., Garcia-De-La-Maria C., Fita G., Gatell J.M., Heras M., Campagnac C., Llopis J., Marco F., Mestres C.A., Moreno A., Ninot S., Pare C., Pericas J.M., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Leoni M.E.G., Robles J.A.G., Ramallo V.G., Cruz A.F., Kestler M., Marin M., Selles M.M., Abella H.R., Roda J.R., Lopez R.A., Pinilla B., Pinto A., Valerio M., Vazquez P., Verde E., Almirante B., 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 J.L., Kauffman C., Bedimo R., Corey G.R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Wang A., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., DiPersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Levine D., Riddle J., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Park L.P., Sanderford B., Stafford J., Anstrom K., Karchmer A.W., Sexton D.J., Durack D.T., Eykyn S., Moreillon P., Sexton. D.J., Arnold C.J., Johnson M., Bayer A.S., Bradley S., Giannitsioti E., Miro J.M., Tornos P., Tattevin P., Strahilevitz J., Spelman D., Athan E., Nacinovich F., Lamas C., Barsic B., Fernandez-Hidalgo N., Munoz P., Chu V.H., Clara L., Sanchez M., Casabe J., Cortes C., Oses P.F., Ronderos R., Sucari A., Thierer J., Altclas J., Kogan S., Harris O., Kennedy K., Tan R., Gordon D., Papanicolas L., Korman T., Kotsanas D., Dever R., Jones P., Konecny P., Lawrence R., Rees D., Ryan S., Feneley M.P., Harkness J., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., De Oliveira Ramos A., Weksler C., Ferraiuoli G., Golebiovski W., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Fernandez R., Franco L., Gonzalez J., Jaramillo A.N., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Vincelj J., Freiberger T., Pol J., Zaloudikova B., Ashour Z., Kholy A.E., Mishaal M., Osama D., Rizk H., Aissa N., Alauzet C., Alla F., 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 P.Y., Flecher E., Michelet C., Revest M., Chevalier F., Jeu A., Remadi J.P., Rusinaru D., Tribouilloy C., Bernard Y., Chirouze C., Hoen B., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Helen G., Sofia A., Ioannis D., Thomas T., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Sharma G., Francis J., Nair L., Thomas V., Venugopal K., Hannan M.M., Hurley J.P., Cahan A., Gilon D., Israel S., Korem M., Durante-Mangoni E., Mattucci I., Pinto D., Agrusta F., Senese A., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., Imazio M., Trinchero R., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Carosi G., Magri S., Signorini L., Kanafani Z., Kanj S.S., Sharif-Yakan A., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Murdoch D.R., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Liew Y.-Y., Tan R.-S., Lejko-Zupanc T., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Falces C., Garcia-De-La-Maria C., Fita G., Gatell J.M., and Heras M.

Abstract

Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.Copyright © 2015, American Society for Microbiology.

Published
2015

9. One-year outcome following biological or mechanical valve replacement for infective endocarditis.

Author

Pangercic A., Munoz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., de Alarcon A., Parra R., Alestig E., Johansson M., Olaison L., Snygg-Martin U., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Corey G.R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D.J., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Dipersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Levine D., Riddle J., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Park L.P., Sanderford B., Stafford J., Anstrom K., Bayer A.S., Karchmer A.W., Durack D.T., Eykyn S., Moreillon P., Delahaye F., Chu V.H., Altclas J., Barsic B., Delahaye A., Freiberger T., Gordon D.L., Hannan M.M., Hoen B., Kanj S.S., Lejko-Zupanc T., Mestres C.A., Pachirat O., Pappas P., Lamas C., Selton-Suty C., Tan R., Tattevin P., Wang A., Clara L., Sanchez M., Casabe J., Cortes C., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Kogan S., Spelman D., Athan E., Harris O., Kennedy K., 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 M.P., Harkness J., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., de Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., Tranchesi R.A.M., Paiva M.G., Fortes C.Q., Ramos A.O., Ferraiuoli G., Golebiovski W., Weksler C., Santos M., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Fernandez R., Franco L., Gonzalez J., Jaramillo A.N., Bukovski S., Krajinovic V., Sharma G., Rudez I., Vincelj J., Pol J., Zaloudikova B., Ashour Z., El Kholy A., Mishaal M., Osama D., Rizk H., Aissa N., Alauzet C., Alla F., Campagnac C., Doco-Lecompte T., Goehringer F., Casalta J.-P., Fournier P.-E., Habib G., Raoult D., Thuny F., Vandenesch F., Donal E., Donnio P.Y., Flecher E., Michelet C., Revest M., Chevalier F., Jeu A., Remadi J.P., Rusinaru D., Tribouilloy C., Bernard Y., Chirouze C., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Thomas T., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Papanikolaou K., Francis J., Nair L., Thomas V., Venugopal K., Hannan M., Hurley J., Cahan A., Gilon D., Israel S., Korem M., Strahilevitz J., Durante-Mangoni E., Mattucci I., Pinto D., Agrusta F., Senese A., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., 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., Anouti K., Chahoud J., Kanafani Z., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., van der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Murdoch D.R., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Liew Y.-Y., Tan R.-S., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Garcia-De-la-maria C., Fita G., Gatell J.M., Heras M., Llopis J., Marco F., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J.M., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Pangercic A., Munoz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., de Alarcon A., Parra R., Alestig E., Johansson M., Olaison L., Snygg-Martin U., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Corey G.R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D.J., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Dipersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Levine D., Riddle J., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Park L.P., Sanderford B., Stafford J., Anstrom K., Bayer A.S., Karchmer A.W., Durack D.T., Eykyn S., Moreillon P., Delahaye F., Chu V.H., Altclas J., Barsic B., Delahaye A., Freiberger T., Gordon D.L., Hannan M.M., Hoen B., Kanj S.S., Lejko-Zupanc T., Mestres C.A., Pachirat O., Pappas P., Lamas C., Selton-Suty C., Tan R., Tattevin P., Wang A., Clara L., Sanchez M., Casabe J., Cortes C., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Kogan S., Spelman D., Athan E., Harris O., Kennedy K., 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 M.P., Harkness J., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., de Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., Tranchesi R.A.M., Paiva M.G., Fortes C.Q., Ramos A.O., Ferraiuoli G., Golebiovski W., Weksler C., Santos M., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Fernandez R., Franco L., Gonzalez J., Jaramillo A.N., Bukovski S., Krajinovic V., Sharma G., Rudez I., Vincelj J., Pol J., Zaloudikova B., Ashour Z., El Kholy A., Mishaal M., Osama D., Rizk H., Aissa N., Alauzet C., Alla F., Campagnac C., Doco-Lecompte T., Goehringer F., Casalta J.-P., Fournier P.-E., Habib G., Raoult D., Thuny F., Vandenesch F., Donal E., Donnio P.Y., Flecher E., Michelet C., Revest M., Chevalier F., Jeu A., Remadi J.P., Rusinaru D., Tribouilloy C., Bernard Y., Chirouze C., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Thomas T., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Papanikolaou K., Francis J., Nair L., Thomas V., Venugopal K., Hannan M., Hurley J., Cahan A., Gilon D., Israel S., Korem M., Strahilevitz J., Durante-Mangoni E., Mattucci I., Pinto D., Agrusta F., Senese A., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., 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., Anouti K., Chahoud J., Kanafani Z., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., van der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Murdoch D.R., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Liew Y.-Y., Tan R.-S., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Garcia-De-la-maria C., Fita G., Gatell J.M., Heras M., Llopis J., Marco F., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J.M., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., and Marin M.

Abstract

Methods and results Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54 years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p = 0.0009) and 25.3% vs 16.6% (p <.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10 years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298). Conclusions Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction. Background Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Published
2014

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

Author

Chambers, ST, Murdoch, DR, Morris, A, Holland, D, Pappas, P, Almela, M, Ferna´ndez-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, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Casabe´, J, Cortes, C, Altclas, J, Silvia 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, de Brito, ACP, Guimara~es, AC, Grinberg, M, Mansur, AJ, Siciliano, RF, Strabelli, TMV, Vieira, MLC, de Medeiros Tranchesi, RA, Paiva, MG, Fortes, CQ, de Oliveira Ramos, A, 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, Kholy, AE, Mishaal, M, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, C, Chambers, ST, Murdoch, DR, Morris, A, Holland, D, Pappas, P, Almela, M, Ferna´ndez-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, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Casabe´, J, Cortes, C, Altclas, J, Silvia 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, de Brito, ACP, Guimara~es, AC, Grinberg, M, Mansur, AJ, Siciliano, RF, Strabelli, TMV, Vieira, MLC, de Medeiros Tranchesi, RA, Paiva, MG, Fortes, CQ, de Oliveira Ramos, A, 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, Kholy, AE, Mishaal, M, Rizk, H, Aissa, N, Alauzet, C, Alla, F, and Campagnac, C

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. © 2013 Chambers et al.

Published
2013

11. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke.

Author

Zaloudikova B., Garcia-De-La-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Munoz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., De Alarcon A., Parra R., Alestig E., Johansson M., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Corey G.R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Di Persio J., Salstrom S.-J., Baddley J., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Cabell C.H., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Barsic B., Dickerman S., Krajinovic V., Pappas P., Altclas J., Carosi G., Casabe J.H., Chu V.H., Delahaye F., Edathodu J., Fortes C.Q., Olaison L., Pangercic A., Patel M., Rudez I., Tamin S.S., Vincelj J., Bayer A.S., Wang A., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., 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 M.P., Harkness J., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., De Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Cereceda M., Fica A., Mella R.M., Bukovski S., Freiberger T., Pol J., Sharma G., Ashour Z., Kholy A.E., 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 A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Revest M., Tattevin P., Violette J., Chevalier F., Jeu A., Rusinaru D., Sorel C., Tribouilloy C., Bernard Y., Chirouze C., Hoen B., Leroy J., Plesiat P., Naber G.C., Neuerburg C., Mazaheri B., Naber C., Athanasia S., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Francis J., Nair L., Thomas D.M.V., Venugopal K., Hannan M., Hurley J., Cahan A., Gilon D., Israel S., Korem M., Strahilevitz J., Tripodi M.F., Casillo R., Cuccurullo S., Dialetto G., Durante-Mangoni E., Irene M., Ragone E., Utili R., Cecchi E., Rosa F.D., Forno D., Imazio M., Trinchero R., Tebini A., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Magri S., Signorini L., Baban T., Kanafani Z., Kanj S.S., Sfeir J., Yasmine M., Abidin I., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Murdoch D.R., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., 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., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Zaloudikova B., Garcia-De-La-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Munoz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., De Alarcon A., Parra R., Alestig E., Johansson M., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Corey G.R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Di Persio J., Salstrom S.-J., Baddley J., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Cabell C.H., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Barsic B., Dickerman S., Krajinovic V., Pappas P., Altclas J., Carosi G., Casabe J.H., Chu V.H., Delahaye F., Edathodu J., Fortes C.Q., Olaison L., Pangercic A., Patel M., Rudez I., Tamin S.S., Vincelj J., Bayer A.S., Wang A., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., 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 M.P., Harkness J., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., De Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Cereceda M., Fica A., Mella R.M., Bukovski S., Freiberger T., Pol J., Sharma G., Ashour Z., Kholy A.E., 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 A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Revest M., Tattevin P., Violette J., Chevalier F., Jeu A., Rusinaru D., Sorel C., Tribouilloy C., Bernard Y., Chirouze C., Hoen B., Leroy J., Plesiat P., Naber G.C., Neuerburg C., Mazaheri B., Naber C., Athanasia S., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Francis J., Nair L., Thomas D.M.V., Venugopal K., Hannan M., Hurley J., Cahan A., Gilon D., Israel S., Korem M., Strahilevitz J., Tripodi M.F., Casillo R., Cuccurullo S., Dialetto G., Durante-Mangoni E., Irene M., Ragone E., Utili R., Cecchi E., Rosa F.D., Forno D., Imazio M., Trinchero R., Tebini A., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Magri S., Signorini L., Baban T., Kanafani Z., Kanj S.S., Sfeir J., Yasmine M., Abidin I., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Murdoch D.R., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., 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., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., and Falces C.

Abstract

Background. The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. Methods. Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. Results. Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval[CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650). Conclusions. There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.Copyright © The Author 2012.

Published
2013

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

Author

Revest M., Kirill O., Vadim K., Vinogradova T., 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., Almela M., Armero Y., Azqueta M., Castan~eda X., Cervera C., Rio A., Falces C., Garcia-de-la-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Mun~oz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., de Alarcon A., Parra R., Alestig E., Johansson M., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., DiPersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Baloch K., Corey G.R., Dixon C.C., Fowler Jr. V.G., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Chu V.H., Karchmer A.W., Murdoch D.R., Sexton D.J., Wang A., Bayer A.S., Cabell C.H., Chu V., Durack D.T., Eykyn S., Hoen B., Moreillon P., Olaison L., Raoult D., Rubinstein E., Chambers S.T., Murdoch D., Bouza E., Hannan M.M., Kanafani Z.A., Lang S., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., Altclas J., Silvia 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., Konecny P., Lawrence R., Rees D., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Ryan S., Gattringer R., Wiesbauer F., Andrade A.R., de Brito A.C.P., Guimara~es A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., de Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., de Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Vincelj J., Freiberger T., Pol J., Zaloudikova B., Ashour Z., Kholy A.E., 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., Thuny F., Delahaye F., Delahaye A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Sharma G., Tattevin P., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Tribouilloy C., Bernard Y., Chirouze C., Leroy J., Plesiat P., Naber C., Mazaheri B., Neuerburg C., Athanasia S., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Francis J., Nair L., Thomas V., Venugopal K., Hannan M., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Tripodi M.F., Casillo R., Cuccurullo S., Dialetto G., Durante-Mangoni E., Irene M., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., 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 S.S., Sfeir J., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., van der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Revest M., Kirill O., Vadim K., Vinogradova T., 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., Almela M., Armero Y., Azqueta M., Castan~eda X., Cervera C., Rio A., Falces C., Garcia-de-la-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Mun~oz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., de Alarcon A., Parra R., Alestig E., Johansson M., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., DiPersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Baloch K., Corey G.R., Dixon C.C., Fowler Jr. V.G., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Chu V.H., Karchmer A.W., Murdoch D.R., Sexton D.J., Wang A., Bayer A.S., Cabell C.H., Chu V., Durack D.T., Eykyn S., Hoen B., Moreillon P., Olaison L., Raoult D., Rubinstein E., Chambers S.T., Murdoch D., Bouza E., Hannan M.M., Kanafani Z.A., Lang S., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., Altclas J., Silvia 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., Konecny P., Lawrence R., Rees D., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Ryan S., Gattringer R., Wiesbauer F., Andrade A.R., de Brito A.C.P., Guimara~es A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., de Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., de Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Vincelj J., Freiberger T., Pol J., Zaloudikova B., Ashour Z., Kholy A.E., 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., Thuny F., Delahaye F., Delahaye A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Sharma G., Tattevin P., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Tribouilloy C., Bernard Y., Chirouze C., Leroy J., Plesiat P., Naber C., Mazaheri B., Neuerburg C., Athanasia S., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Francis J., Nair L., Thomas V., Venugopal K., Hannan M., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Tripodi M.F., Casillo R., Cuccurullo S., Dialetto G., Durante-Mangoni E., Irene M., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., 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 S.S., Sfeir J., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., van der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., and Chipigina N.

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. © 2013 Chambers et al.

Published
2013

13. 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

14. Non-HACEK gram-negative bacillus endocarditis.

Author

Delahaye F., Patel M., Dismukes W., Pan A., Caros G., Tribouilloy A.B.M.C., Ramallo V., Raoult D., Thuny F., Habib G., Casalta J.-P., Fournier P.-E., Chipigina N., Kirill O., Vinogradova T., Kulichenko V.P., Butkevich O.M., Lion C., Selton-Suty C., Alla F., Coyard H., Doco-Lecompte T., Durante-Mangoni E., Ragone E., Dialetto G., Tripodi M.F., Utili R., Casillo R., Kumar A.S., Sharma G., Street A., Eisen D.P., McBryde E.S., Grigg L., Abrutyn E., Michelet C., Donnio P.Y., Fortes C.Q., Edathodu J., Al-Hegelan M., Font B., Anguera I., Guma J.R., Cereceda M., Oyonarte M.J., Mella R.M., Garcia P., Jones S.B., Paiva M.G., Tranchesi R.A.D.M., Woon L.L., Lum L.-N., Tan R.-S., Rees D., Kornecny P., Lawrence R., Dever R., Post J., Jones P., Ryan S., Harkness J., Feneley M., Rubinstein E., Strahilewitz J., Ionac A., Mornos C., Dragulescu S., Forno D., Cecchi E., De Rosa F., Imazio M., Trinchero R., Wiesbauer F., Gattringer R., Deans G., Andrasevic A.T., Barsic B., Klinar I., Vincelj J., Bukovski S., Krajinovic V., Stafford J., Baloch K., Redick T., Harding T., Bayer A.S., Durack D.T., Moreillon P., Eykyn S., Morpeth S., Murdoch D., Cabell C.H., Karchmer A.W., Pappas P., Levine D., Nacinovich F., Tattevin P., Fernandez-Hidalgo N., Dickerman S., Bouza E., Del Rio A., Lejko-Zupanc T., De Oliveira Ramos A., Iarussi D., Klein J., Chirouze C., Bedimo R., Corey G.R., Fowler Jr. V.G., Gordon D., Devi U., Spelman D., Van Der Meer J.T.M., Kauffman C., Bradley S., Armstrong W., Giannitsioti E., Giamarellou H., Lerakis S., Moreno A., Mestres C.A., Pare C., Garcia De La Maria C., De Lazzario E., Marco F., Gatell J.M., Miro J.M., Almela M., Azqueta M., Jimenez-Exposito M.J., De Benito N., Perez N., Almirante B., Rodriguez De Vera P., Tornos P., Falco V., Claramonte X., Armero Y., Sidani N., Kanj-Sharara S., Kanafani Z., Raglio A., Goglio A., Gnecchi F., Suter F., Valsecchi G., Rizzi M., Ravasio V., Hoen B., Leroy J., Plesiat P., Bernard Y., Casey A., Lambert P., Watkin R., Elliott T., Goissen T., Delahaye A., Vandenesch F., Vizzotti C., Nacinovich F.M., Trivi M., Lombardero M., Cortes C., Casabe J.H., Altclas J., Kogan S., Clara L., Sanchez M., Commerford A., Hansa C., Deetlefs E., Ntsekhe M., Commerford P., Wray D., Steed L.L., Church P., Cantey R., Morris A., Chambers S., Read K., Raymond N., Holland D., Lang S., Kotsanas D., Korman T.M., Peterson G., Purcell J., Southern Jr. P.M., Shah M., Reddy A., Dhar G., Hanlon-Feeney A., Hannan M., Kelly S., Wang A., Woods C.W., Sexton D.J., Benjamin Jr. D., McDonald J.R., Federspiel J., Engemann J.J., Reller L.B., Drew L., Caram L.B., Stryjewski M., Lalani T., Chu V., Mazaheri B., Neuerburg C., Naber C., Athan E., Henry M., Harris O., Alestig E., Olaison L., Wikstrom L., Snygg-Martin U., Francis J., Venugopal K., Nair L., Thomas V., Chaiworramukkun J., Pachirat O., Chetchotisakd P., Suwanich T., Kamarulzaman A., Tamin S.S., Mueller Premru M., Logar M., Orezzi C., Moreno M., Rodriguez-Creixems M., Marin M., Fernandez M., Munoz P., Fernandez R., Delahaye F., Patel M., Dismukes W., Pan A., Caros G., Tribouilloy A.B.M.C., Ramallo V., Raoult D., Thuny F., Habib G., Casalta J.-P., Fournier P.-E., Chipigina N., Kirill O., Vinogradova T., Kulichenko V.P., Butkevich O.M., Lion C., Selton-Suty C., Alla F., Coyard H., Doco-Lecompte T., Durante-Mangoni E., Ragone E., Dialetto G., Tripodi M.F., Utili R., Casillo R., Kumar A.S., Sharma G., Street A., Eisen D.P., McBryde E.S., Grigg L., Abrutyn E., Michelet C., Donnio P.Y., Fortes C.Q., Edathodu J., Al-Hegelan M., Font B., Anguera I., Guma J.R., Cereceda M., Oyonarte M.J., Mella R.M., Garcia P., Jones S.B., Paiva M.G., Tranchesi R.A.D.M., Woon L.L., Lum L.-N., Tan R.-S., Rees D., Kornecny P., Lawrence R., Dever R., Post J., Jones P., Ryan S., Harkness J., Feneley M., Rubinstein E., Strahilewitz J., Ionac A., Mornos C., Dragulescu S., Forno D., Cecchi E., De Rosa F., Imazio M., Trinchero R., Wiesbauer F., Gattringer R., Deans G., Andrasevic A.T., Barsic B., Klinar I., Vincelj J., Bukovski S., Krajinovic V., Stafford J., Baloch K., Redick T., Harding T., Bayer A.S., Durack D.T., Moreillon P., Eykyn S., Morpeth S., Murdoch D., Cabell C.H., Karchmer A.W., Pappas P., Levine D., Nacinovich F., Tattevin P., Fernandez-Hidalgo N., Dickerman S., Bouza E., Del Rio A., Lejko-Zupanc T., De Oliveira Ramos A., Iarussi D., Klein J., Chirouze C., Bedimo R., Corey G.R., Fowler Jr. V.G., Gordon D., Devi U., Spelman D., Van Der Meer J.T.M., Kauffman C., Bradley S., Armstrong W., Giannitsioti E., Giamarellou H., Lerakis S., Moreno A., Mestres C.A., Pare C., Garcia De La Maria C., De Lazzario E., Marco F., Gatell J.M., Miro J.M., Almela M., Azqueta M., Jimenez-Exposito M.J., De Benito N., Perez N., Almirante B., Rodriguez De Vera P., Tornos P., Falco V., Claramonte X., Armero Y., Sidani N., Kanj-Sharara S., Kanafani Z., Raglio A., Goglio A., Gnecchi F., Suter F., Valsecchi G., Rizzi M., Ravasio V., Hoen B., Leroy J., Plesiat P., Bernard Y., Casey A., Lambert P., Watkin R., Elliott T., Goissen T., Delahaye A., Vandenesch F., Vizzotti C., Nacinovich F.M., Trivi M., Lombardero M., Cortes C., Casabe J.H., Altclas J., Kogan S., Clara L., Sanchez M., Commerford A., Hansa C., Deetlefs E., Ntsekhe M., Commerford P., Wray D., Steed L.L., Church P., Cantey R., Morris A., Chambers S., Read K., Raymond N., Holland D., Lang S., Kotsanas D., Korman T.M., Peterson G., Purcell J., Southern Jr. P.M., Shah M., Reddy A., Dhar G., Hanlon-Feeney A., Hannan M., Kelly S., Wang A., Woods C.W., Sexton D.J., Benjamin Jr. D., McDonald J.R., Federspiel J., Engemann J.J., Reller L.B., Drew L., Caram L.B., Stryjewski M., Lalani T., Chu V., Mazaheri B., Neuerburg C., Naber C., Athan E., Henry M., Harris O., Alestig E., Olaison L., Wikstrom L., Snygg-Martin U., Francis J., Venugopal K., Nair L., Thomas V., Chaiworramukkun J., Pachirat O., Chetchotisakd P., Suwanich T., Kamarulzaman A., Tamin S.S., Mueller Premru M., Logar M., Orezzi C., Moreno M., Rodriguez-Creixems M., Marin M., Fernandez M., Munoz P., and Fernandez R.

Abstract

Background: Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. Objective(s): To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. Design(s): Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. Setting(s): 61 hospitals in 28 countries. Patient(s): Hospitalized patients with definite endocarditis. Measurements: Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens. Result(s): Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%). Limitation(s): Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make. Conclusion(s): In this large, prospective, multinational

Published
2008

20. Non-HACEK gram-negative bacillus endocarditis

Author

Morpeth, S, Murdoch, D, Cabell, Ch, Karchmer, Aw, Pappas, P, Levine, D, Nacinovich, F, Tattevin, P, Fernández Hidalgo, N, Dickerman, S, Bouza, E, del Río, A, Lejko Zupanc, T, de Oliveira Ramos, A, Iarussi, D, Klein, J, Chirouze, C, Bedimo, R, Corey, Gr, Fowler VG Jr, Collaborators: Gordon D, International Collaboration on Endocarditis Prospective Cohort Study I. n. v. e. s. t. i. g. a. t. o. r. s., Devi, U, Spelman, D, van der Meer JT, Kauffman, C, Bradley, S, Armstrong, W, Giannitsioti, E, Giamarellou, H, Lerakis, S, del Rio, A, Moreno, A, Mestres, Ca, Paré, C, Garcia de la Maria, C, De Lazzario, E, Marco, F, Gatell, Jm, Miró, Jm, Almela, M, Azqueta, M, Jiménez Expósito MJ, de Benito, N, Perez, N, Almirante, B, Fernandez Hidalgo, N, Rodriguez de Vera, P, Tornos, P, Falcó, V, Claramonte, X, Armero, Y, Sidani, N, Kanj Sharara, S, Kanafani, Z, Raglio, A, Goglio, A, Gnecchi, F, Suter, F, Valsecchi, G, Rizzi, M, Ravasio, V, Hoen, B, Leroy, J, Plesiat, P, Bernard, Y, Casey, A, Lambert, P, Watkin, R, Elliott, T, Patel, M, Dismukes, W, Pan, A, Caros, G, Tribouilloy, Ab, Goissen, T, Delahaye, A, Delahaye, F, Vandenesch, F, Vizzotti, C, Nacinovich, Fm, Marin, M, Trivi, M, Lombardero, M, Cortes, C, Horacio Casabe, J, Altclas, J, Kogan, S, Clara, L, Sanchez, M, Commerford, A, Hansa, C, Deetlefs, E, Ntsekhe, M, Commerford, P, Wray, D, Steed, Ll, Church, P, Cantey, R, Morris, A, Read, K, Raymond, N, Lang, S, Chambers, S, Kotsanas, D, Korman, Tm, Peterson, G, Purcell, J, Southern PM Jr, Shah, M, Reddy, A, Dhar, G, Hanlon Feeney, A, Hannan, M, Kelly, S, Wang, A, Woods, Cw, Sexton, Dj, Benjamin D., Jr, Mcdonald, Jr, Federspiel, J, Engemann, Jj, Reller, Lb, Drew, L, Caram, Lb, Stryjewski, M, Lalani, T, Fowler V., Jr, Chu, V, Mazaheri, B, Neuerburg, C, Naber, C, Athan, E, Henry, M, Harris, O, Alestig, E, Olaison, L, Wikstrom, L, Snygg Martin, U, Francis, J, Venugopal, K, Nair, L, Thomas, V, Chaiworramukkun, J, Pachirat, O, Chetchotisakd, P, Suwanich, T, Kamarulzaman, A, Tamin, Ss, Premru, Mm, Logar, M, Orezzi, C, Moreno, M, Rodríguez Créixems, M, Fernández, M, Muñoz, P, Fernández, R, Ramallo, V, Raoult, D, Thuny, F, Habib, G, Casalta, Jp, Fournier, Pe, Chipigina, N, Kirill, O, Vinogradova, T, Kulichenko, Vp, Butkevich, Om, Lion, C, Alla, F, Coyard, H, Doco Lecompte, T, Durante Mangoni, E, Ragone, E, Dialetto, G, Tripodi, Mf, Utili, R, Casillo, R, Kumar, As, Sharma, G, Dickerman, Sa, Street, A, Eisen, Dp, Mcbryde, Es, Grigg, L, Abrutyn, E, Michelet, C, Donnio, Py, Fortes, Cq, Edathodu, J, Al Hegelan, M, Font, B, Anguera, I, Raimon Guma, J, Cereceda, M, Oyonarte, Mj, Montagna Mella, R, Garcia, P, Braun Jones, S, de Oliveira Ramos AI, Paiva, Mg, de Medeiros RA, Woon, Ll, Lum, Ln, Tan, Rs, Rees, D, Koneçny, P, Lawrence, R, Dever, R, Post, J, Jones, P, Ryan, S, Harkness, J, Feneley, M, Rubinstein, E, Strahilewitz, J, Ionac, A, Mornos, C, Dragulescu, S, Forno, D, Cecchi, E, DE ROSA, Francesco Giuseppe, Imazio, M, Trinchero, R, Wiesbauer, F, Gattringer, R, Deans, G, Andrasevic, At, Barsic, B, Klinar, I, Vincelj, J, Bukovski, S, Krajinovic, V, Cabell, C, Stafford, J, Baloch, K, Redick, T, Harding, T, Bayer, A, Durack, Dt, Corey, R, Moreillon, P, Eykynm, S, and Chu, V.

Subjects
Eikenella corrodens, Microbiology, stomatognathic system, Haemophilus, Gram-Negative Bacteria, Internal Medicine, medicine, Endocarditis, Humans, Prospective Studies, Cardiac Surgical Procedures, Substance Abuse, Intravenous, Cross Infection, biology, business.industry, Gram Negative Bacillus, General Medicine, Endocarditis, Bacterial, Prostheses and Implants, biology.organism_classification, medicine.disease, Anti-Bacterial Agents, Community-Acquired Infections, stomatognathic diseases, Treatment Outcome, Infective endocarditis, Bacteremia, Actinobacillus, bacteria, Cardiobacterium hominis, business, Gram-Negative Bacterial Infections
Abstract

Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users.To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients.Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database.61 hospitals in 28 countries.Hospitalized patients with definite endocarditis.Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens.Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%).Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make.In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.

21. Infective Endocarditis in Patients on Chronic Hemodialysis

Author

Juan M. Pericàs, Jaume Llopis, Maria Jesús Jiménez-Exposito, Wissam M. Kourany, Benito Almirante, Giampiero Carosi, Emanuele Durante-Mangoni, Claudio Querido Fortes, Efthymia Giannitsioti, Stamatios Lerakis, Rodrigo Montagna-Mella, Juan Ambrosioni, Ru-San Tan, Carlos A. Mestres, Dannah Wray, Orathai Pachirat, Asuncion Moreno, Vivian H. Chu, Elisa de Lazzari, Vance G. Fowler, Jose M. Miró, Liliana Clara, Marisa Sanchez, José Casabé, Claudia Cortes, Francisco Nacinovich, Pablo Fernandez Oses, Ricardo Ronderos, Adriana Sucari, Jorge Thierer, Javier Altclas, Silvia Kogan, Denis Spelman, Eugene Athan, Owen Harris, Karina Kennedy, Ren Tan, David Gordon, Lito Papanicolas, Tony Korman, Despina Kotsanas, Robyn Dever, Phillip Jones, Pam Konecny, Richard Lawrence, David Rees, Suzanne Ryan, Michael P. Feneley, John Harkness, Jeffrey Post, Porl Reinbott, Rainer Gattringer, Franz Wiesbauer, Adriana Ribas Andrade, Ana Cláudia Passos de Brito, Armenio Costa Guimarães, Max Grinberg, Alfredo José Mansur, Rinaldo Focaccia Siciliano, Tania Mara Varejao Strabelli, Marcelo Luiz Campos Vieira, Regina Aparecida de Medeiros Tranchesi, Marcelo Goulart Paiva, Auristela de Oliveira Ramos, Clara Weksler, Giovanna Ferraiuoli, Wilma Golebiovski, Cristiane Lamas, James A. Karlowsky, Yoav Keynan, Andrew M. Morris, Ethan Rubinstein, Sandra Braun Jones, Patricia Garcia, M. Cereceda, Alberto Fica, Rodrigo Montagna Mella, Ricardo Fernandez, Liliana Franco, Javier Gonzalez, Astrid Natalia Jaramillo, Bruno Barsic, Suzana Bukovski, Vladimir Krajinovic, Ana Pangercic, Igor Rudez, Josip Vincelj, Tomas Freiberger, Jiri Pol, Barbora Zaloudikova, Zainab Ashour, Amani El Kholy, Marwa Mishaal, Dina Osama, Hussien Rizk, Neijla Aissa, Corentine Alauzet, Francois Alla, CHU Catherine Campagnac, Thanh Doco-Lecompte, Christine Selton-Suty, Jean-Paul Casalta, Pierre-Edouard Fournier, Gilbert Habib, Didier Raoult, Franck Thuny, Francois Delahaye, Armelle Delahaye, Francois Vandenesch, Erwan Donal, Pierre Yves Donnio, Erwan Flecher, Christian Michelet, Matthieu Revest, Pierre Tattevin, Florent Chevalier, Antoine Jeu, Jean Paul Rémadi, Dan Rusinaru, Christophe Tribouilloy, Yvette Bernard, Catherine Chirouze, Bruno Hoen, Joel Leroy, Patrick Plesiat, Christoph Naber, Carl Neuerburg, Bahram Mazaheri, Carl Neuerburg Sophia Athanasia, Ioannis Deliolanis, Helen Giamarellou, Tsaganos Thomas, Elena Mylona, Olga Paniara, Konstantinos Papanicolaou, John Pyros, Athanasios Skoutelis, Konstantinos Papanikolaou, Gautam Sharma, Johnson Francis, Lathi Nair, Vinod Thomas, Krishnan Venugopal, Margaret M. Hannan, John P. Hurley, Maor Wanounou, Dan Gilon, Sarah Israel, Maya Korem, Jacob Strahilevitz, Domenico Iossa, Serena Orlando, Maria Paola Ursi, Pia Clara Pafundi, Fabiana D’Amico, Mariano Bernardo, Susanna Cuccurullo, Giovanni Dialetto, Franco Enrico Covino, Sabrina Manduca, Alessandro Della Corte, Marisa De Feo, Marie Françoise Tripodi, Enrico Cecchi, Francesco De Rosa, Davide Forno, Massimo Imazio, Rita Trinchero, Paolo Grossi, Mariangela Lattanzio, Antonio Toniolo, Antonio Goglio, Annibale Raglio, Veronica Ravasio, Marco Rizzi, Fredy Suter, Silvia Magri, Liana Signorini, Zeina Kanafani, Souha S. Kanj, Ahmad Sharif-Yakan, Imran Abidin, Syahidah Syed Tamin, Eduardo Rivera Martínez, Gabriel Israel Soto Nieto, Jan T.M. van der Meer, Stephen Chambers, David Holland, Arthur Morris, Nigel Raymond, Kerry Read, David R. Murdoch, Stefan Dragulescu, Adina Ionac, Cristian Mornos, O.M. Butkevich, Natalia Chipigina, Ozerecky Kirill, Kulichenko Vadim, Tatiana Vinogradova, Jameela Edathodu, Magid Halim, Yee-Yun Liew, Tatjana Lejko-Zupanc, Mateja Logar, Manica Mueller-Premru, Patrick Commerford, Anita Commerford, Eduan Deetlefs, Cass Hansa, Mpiko Ntsekhe, Manel Almela, Manuel Azqueta, Merce Brunet, Pedro Castro, Elisa De Lazzari, Carlos Falces, David Fuster, Guillermina Fita, Cristina Garcia- de- la- Maria, Javier Garcia-Gonzalez, Jose M. Gatell, Francesc Marco, José M. Miró, José Ortiz, Salvador Ninot, J. Carlos Paré, Juan M. Pericas, Eduard Quintana, Jose Ramirez, Irene Rovira, Elena Sandoval, Marta Sitges, Adrian Tellez, José M. Tolosana, Barbara Vidal, Jordi Vila, Ignasi Anguera, Bernat Font, Joan Raimon Guma, Javier Bermejo, Emilio Bouza, Miguel Angel Garcia Fernández, Victor Gonzalez-Ramallo, Mercedes Marín, Patricia Muñoz, Miguel Pedromingo, Jorge Roda, Marta Rodríguez-Créixems, Jorge Solis, Nuria Fernandez-Hidalgo, Pilar Tornos, Arístides de Alarcón, Ricardo Parra, Eric Alestig, Magnus Johansson, Lars Olaison, Ulrika Snygg-Martin, Pimchitra Pachirat, Burabha Pussadhamma, Vichai Senthong, Anna Casey, Tom Elliott, Peter Lambert, Richard Watkin, Christina Eyton, John L. Klein, Suzanne Bradley, Carol Kauffman, Roger Bedimo, G. Ralph Corey, Anna Lisa Crowley, Pamela Douglas, Laura Drew, Thomas Holland, Tahaniyat Lalani, Daniel Mudrick, Zaniab Samad, Daniel Sexton, Martin Stryjewski, Andrew Wang, Christopher W. Woods, Robert Cantey, Lisa Steed, Stuart A. Dickerman, Hector Bonilla, Joseph DiPersio, Sara-Jane Salstrom, John Baddley, Mukesh Patel, Gail Peterson, Amy Stancoven, Donald Levine, Jonathan Riddle, Michael Rybak, Christopher H. Cabell, Pericas, J. M., Llopis, J., Jimenez-Exposito, M. J., Kourany, W. M., Almirante, B., Carosi, G., Durante-Mangoni, E., Fortes, C. Q., Giannitsioti, E., Lerakis, S., Montagna-Mella, R., Ambrosioni, J., Tan, R. -S., Mestres, C. A., Wray, D., Pachirat, O., Moreno, A., Chu, V. H., de Lazzari, E., Fowler, V. G., Miro, J. M., Clara, L., Sanchez, M., Casabe, J., Cortes, C., Nacinovich, F., Oses, P. F., Ronderos, R., Sucari, A., Thierer, J., Altclas, J., Kogan, S., Spelman, D., Athan, E., Harris, O., Kennedy, K., Tan, R., Gordon, D., Papanicolas, L., Korman, T., Kotsanas, D., Dever, R., Jones, P., Konecny, P., Lawrence, R., Rees, D., Ryan, S., Feneley, M. P., Harkness, J., Post, J., Reinbott, P., Gattringer, R., Wiesbauer, F., Andrade, A. R., Passos de Brito, A. C., Guimaraes, A. C., Grinberg, M., Mansur, A. J., Siciliano, R. F., Varejao Strabelli, T. M., Campos Vieira, M. L., de Medeiros Tranchesi, R. A., Paiva, M. G., de Oliveira Ramos, A., Weksler, C., Ferraiuoli, G., Golebiovski, W., Lamas, C., Karlowsky, J. A., Keynan, Y., Morris, A. M., Rubinstein, E., Jones, S. B., Garcia, P., Cereceda, M., Fica, A., Mella, R. M., Fernandez, R., Franco, L., Gonzalez, J., Jaramillo, A. N., 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., Osama, D., Rizk, H., Aissa, N., Alauzet, C., Alla, F., Campagnac, C. 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, P. Y., Flecher, E., Michelet, C., Revest, M., Tattevin, P., Chevalier, F., Jeu, A., Remadi, J. P., Rusinaru, D., Tribouilloy, C., Bernard, Y., Chirouze, C., Hoen, B., Leroy, J., Plesiat, P., Naber, C., Neuerburg, C., Mazaheri, B., Sophia Athanasia, C. N., Deliolanis, I., Giamarellou, H., Thomas, T., Mylona, E., Paniara, O., Papanicolaou, K., Pyros, J., Skoutelis, A., Papanikolaou, K., Sharma, G., Francis, J., Nair, L., Thomas, V., Venugopal, K., Hannan, M. M., Hurley, J. P., Wanounou, M., Gilon, D., Israel, S., Korem, M., Strahilevitz, J., Iossa, D., Orlando, S., Ursi, M. P., Pafundi, P. C., D'Amico, F., Bernardo, M., Cuccurullo, S., Dialetto, G., Covino, F. E., Manduca, S., Della Corte, A., De Feo, M., Tripodi, M. F., Cecchi, E., De Rosa, F., Forno, D., Imazio, M., Trinchero, R., Grossi, P., Lattanzio, M., Toniolo, A., Goglio, A., Raglio, A., Ravasio, V., Rizzi, M., Suter, F., Magri, S., Signorini, L., Kanafani, Z., Kanj, S. S., Sharif-Yakan, A., Abidin, I., Tamin, S. S., Martinez, E. R., Soto Nieto, G. I., van der Meer, J. T. M., Chambers, S., Holland, D., Morris, A., Raymond, N., Read, K., Murdoch, D. R., Dragulescu, S., Ionac, A., Mornos, C., Butkevich, O. M., Chipigina, N., Kirill, O., Vadim, K., Vinogradova, T., Edathodu, J., Halim, M., Liew, Y. -Y., Lejko-Zupanc, T., Logar, M., Mueller-Premru, M., Commerford, P., Commerford, A., Deetlefs, E., Hansa, C., Ntsekhe, M., Almela, M., Azqueta, M., Brunet, M., Castro, P., Falces, C., Fuster, D., Fita, G., Garcia- de- la- Maria, C., Garcia-Gonzalez, J., Gatell, J. M., Marco, F., Ortiz, J., Ninot, S., Pare, J. C., Quintana, E., Ramirez, J., Rovira, I., Sandoval, E., Sitges, M., Tellez, A., Tolosana, J. M., Vidal, B., Vila, J., Anguera, I., Font, B., Guma, J. R., Bermejo, J., Bouza, E., Garcia Fernandez, M. A., Gonzalez-Ramallo, V., Marin, M., Munoz, P., Pedromingo, M., Roda, J., Rodriguez-Creixems, M., Solis, J., Fernandez-Hidalgo, N., Tornos, P., de Alarcon, A., Parra, R., Alestig, E., Johansson, M., Olaison, L., Snygg-Martin, U., Pachirat, P., Pussadhamma, B., Senthong, V., Casey, A., Elliott, T., Lambert, P., Watkin, R., Eyton, C., Klein, J. L., Bradley, S., Kauffman, C., Bedimo, R., Corey, G. R., Crowley, A. L., Douglas, P., Drew, L., Holland, T., Lalani, T., Mudrick, D., Samad, Z., Sexton, D., Stryjewski, M., Wang, A., Woods, C. W., Cantey, R., Steed, L., Dickerman, S. A., Bonilla, H., Dipersio, J., Salstrom, S. -J., Baddley, J., Patel, M., Peterson, G., Stancoven, A., Levine, D., Riddle, J., Rybak, M., Cabell, C. H., Bristol-Myers Squibb Company, Vall d'Hebron University Hospital [Barcelona], Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Laboratoire Chrono-environnement (UMR 6249) (LCE)

Subjects
Male, relapses, medicine.medical_treatment, infective endocarditi, 030204 cardiovascular system & hematology, Kidney Failure, Cohort Studies, Catheters, Indwelling, 0302 clinical medicine, Surgical, Epidemiology, cardiac surgery, enterococci, hemodialysis, infective endocarditis, Staphylococcus aureus, Aged, Anti-Bacterial Agents, Arteriovenous Shunt, Surgical, Cardiac Surgical Procedures, Endocarditis, Female, Humans, Kidney Failure, Chronic, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Renal Dialysis, Staphylococcal Infections, 030212 general & internal medicine, Chronic, Prospective cohort study, health care economics and organizations, relapse, Arteriovenous Shunt, 3. Good health, Cardiac surgery, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Indwelling, Infective endocarditis, Hemodialysis, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Catheters, education, 03 medical and health sciences, Internal medicine, medicine, business.industry, medicine.disease, hemodialysi, Etiology, Complication, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background - Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives - This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods - Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results - A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non-HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p

Published
2021
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22. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study

Author

Murdoch , David R, Corey , G Ralph, Hoen , Bruno, Miró , José M, Fowler , Vance G, Bayer , Arnold S, Karchmer , Adolf W, Olaison , Lars, Pappas , Paul A, Moreillon , Philippe, Chambers , Stephen T, Chu , Vivian H, Falcó , Vicenç, Holland , David J, Jones , Philip, Klein , John L, Raymond , Nigel J, Read , Kerry M, Tripodi , Marie Francoise, Utili , Riccardo, Wang , Andrew, Woods , Christopher W, Cabell , Christopher H, Renseigné , Non, International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators, Gordon, D., Devi, U., Spelman, D., van der Meer, J.T., Kauffman, C., Bradley, S., Armstrong, W., Giannitsioti, E., Giamarellou, H., Lerakis, S., del Rio, A., Moreno, A., Mestres, C.A., Ninot, C.A., Pare, C., de la Maria, C.G., Armero, Y., de Lazzari, E., Marco, F., Gatell, J.M., Almela, M., Azqueta, M., Sitges, M., Claramonte, X., Jiménez-Expósito, M.J., de Benito, N., Ramirez, J., Perez, N., Miro, J.M., Almirante, B., Fernandez-Hidalgo, N., de Vera, P.R., Tornos, P., Falco, V., Sidani, N., Kanj-Sharara, S., Kanafani, Z., Raglio, A., Goglio, A., Gnecchi, F., Suter, F., Valsecchi, G., Rizzi, M., Ravasio, V., Hoen, B., Chirouze, C., Leroy, J., Plesiat, P., Bernard, Y., Casey, A., Lambert, P., Watkin, R., Elliott, T., Patel, M., Dismukes, W., Pan, A., Caros, G., Mathiron, A.B., Tribouilloy, C., Goissen, T., Delahaye, A., Delahaye, F., Vandenesch, F., Vizzotti, C., Nacinovich, F.M., Marin, M., Trivi, M., Lombardero, M., Cortes, C., Casabé, J.H., Altclas, J., Kogan, S., Clara, L., Sanchez, M., Commerford, A., Hansa, C., Deetlefs, E., Ntsekhe, M., Commerford, P., Wray, D., Steed, L.L., Church, P., Cantey, R., Morris, A., Holland, D.J., Murdoch, D.R., Chambers, S.T., Read, K.M., Raymond, N.J., Lang, S., Kotsanas, D., Korman, T.M., Peterson, G., Purcell, J., Southern, P.M., Shah, M., Bedimo, R., Reddy, A., Levine, D., Dhar, G., Hanlon-Feeney, A., Hannan, M., Kelly, S., Wang, A., Cabell, C.H., Woods, C.W., Sexton, D.J., Benjamin, D.J., McDonald, J.R., Federspiel, J., Engemann, J.J., Reller, B., Drew, L., Caram, L.B., Stryjewski, M., Morpeth, S., Lalani, T., Fowler, V.G., Chu, V.H., Mazaheri, B., Neuerburg, C., Naber, C., Athan, E., Henry, M., Harris, O., Alestig, E., Olaison, L., Wikstrom, L., Snygg-Martin, U., Francis, J., Venugopal, K., Nair, L., Thomas, V., Chaiworramukkun, J., Pachirat, O., Chetchotisakd, P., Suwanich, T., Kamarulzaman, A., Tamin, S.S., Premru, M.M., Logar, M., Lejko-Zupanc, T., Orezzi, C., Klein, J.L., Bouz, E., Rodríguez-Créixems, M., Marín, M., Fernández, M., Muñoz, P., Fernández, R., Ramallo, V., Raoult, D., Thuny, F., Habib, G., Casalta, J.P., Fournier, P.E., Chipigina, N., Kirill, O., Vinogradova, T., Kulichenko, V.P., Butkevich, O.M., Lion, C., Selton-Suty, C., Coyard, H., Doco-Lecompte, T., Iarussi, D., Durante-Mangoni, E., Ragone, E., Dialetto, G., Tripodi, M.F., Utili, R., Casillo, R., Kumar, A.S., Sharma, G., Dickerman, S.A., Street, A., Eisen, D.P., McBryde, E.S., Grigg, L., Abrutyn, E., Michelet, C., Tattevin, P., Donnio, P.Y., Fortes, C.Q., Edathodu, J., Al-Hegelan, M., Font, B., Anguera, I., Guma, J.R., Cereceda, M., Oyonarte, M.J., Mella, R.M., Garcia, P., Jones, S.B., Ramos, A.I., Paiva, M.G., Tranchesi, R.A., Woon, L.L., Lum, L.N., Tan, R.S., Rees, D., Kornecny, P., Lawrence, R., Dever, R., Post, J., Jones, P., Ryan, S., Harkness, J., Feneley, M., Rubinstein, E., Strahilewitz, J., Ionac, A., Mornos, C., Dragulescu, S., Forno, D., Cecchi, E., De Rosa, F., Imazio, M., Trinchero, R., Wiesbauer, F., Gattringer, R., Deans, G., Andrasevic, A.T., Barsic, B., Klinar, I., Vincelj, J., Bukovski, S., Krajinovic, V., Stafford, J., Baloch, K., Pappas, P.A., Redick, T., Harding, T., Karchmer, A.W., Bayer, A.S., Corey, R., Moreillon, P., Durack, D.T., Eykyn, S., Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Murdoch, D., Corey, G., Miro', J., Fowler, V. J., Bayer, A., Karchmer, A., Pappas, P., Chambers, S., Chu, V., Falco', V., Holland, D., Klein, J., Raymond, N., Read, K., Tripodi, M. F., Utili, Riccardo, Woods, C., Cabell, C., AII - Amsterdam institute for Infection and Immunity, Infectious diseases, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Male, MESH: Endocarditis, MESH : Aged, MESH : Prospective Studies, 030204 cardiovascular system & hematology, endocarditi, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Mitral valve, MESH: Staphylococcus aureus, MESH : Female, Prospective Studies, Prospective cohort study, Abscess, MESH: Aged, Adult, Aged, Endocarditis/microbiology, Endocarditis/mortality, Endocarditis/therapy, Female, Humans, Middle Aged, Staphylococcal Infections/microbiology, Staphylococcus aureus/isolation & purification, endocarditis, hospital mortality, 0303 health sciences, MESH: Middle Aged, Endocarditis, MESH : Staphylococcus aureus, Staphylococcal Infections, MESH : Adult, MESH : Endocarditis, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine.anatomical_structure, Infective endocarditis, epidemiology, Staphylococcus aureus, medicine.medical_specialty, complications, MESH : Male, MESH: Staphylococcal Infections, Staphylococcal infections, Article, 03 medical and health sciences, Endocarditis, clinical presentattion, S. aureus, Internal medicine, Internal Medicine, medicine, MESH : Middle Aged, staphylococci, MESH: Humans, 030306 microbiology, business.industry, clinical presentattion, MESH : Humans, MESH: Adult, Odds ratio, S. aureus, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, MESH: Male, MESH: Prospective Studies, Surgery, Etiology, MESH : Staphylococcal Infections, business, MESH: Female
Abstract

International audience; BACKGROUND: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. RESULTS: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (

Published
2009
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23. The flipped classroom in medical education: A new standard in teaching.

Author

Phillips J and Wiesbauer F

Abstract

Many medical educators, out of necessity imposed by the COVID-19 pandemic, had to flip their classrooms. However, instead of adapting to this new teaching style, many have proceeded in the manner that they have always used to create content, opening a slide deck and inserting content until they are satisfied with the result. When in fact, we know based on evidence and our own experience, that educators should first plan, organize, and storyboard before collecting information into a presentation [1,2]. If educators need to replace real-world teaching and interaction, we believe the next best option is video education, although there are other forms of prework that can be utilized to flip medical classrooms, including short readings and exercises. We discuss the case for flipping medical classrooms, the limitations, and how educators can get started flipping their classrooms today., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Ltd. All rights reserved.)

Published
2022
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24. Lipid profile and long-term outcome in premature myocardial infarction.

Author

Winter MP, Wiesbauer F, Blessberger H, Pavo N, Sulzgruber P, Huber K, Wojta J, Distelmaier K, Lang IM, and Goliasch G

Subjects
Adult, Apolipoproteins B metabolism, Australia epidemiology, Case-Control Studies, Cholesterol, HDL metabolism, Female, Humans, Hyperlipoproteinemia Type II blood, Hyperlipoproteinemia Type II mortality, Male, Myocardial Infarction mortality, Prospective Studies, Risk Assessment, Hyperlipoproteinemia Type II complications, Lipid Metabolism physiology, Myocardial Infarction blood
Abstract

Background: Premature myocardial infarction (≤40 years) represents a rare disease with a distinct risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride-rich lipoproteins. So far high-density and low-density lipoproteins remain the primary targets for risk stratification and treatment evaluation in coronary artery disease, but this strategy might be insensitive in patients with premature myocardial infarction., Aim: Aim of this study was to investigate the predictive value of different lipid fractions on long-term cardiovascular outcome in patients with premature myocardial infarction., Methods: We prospectively enrolled 102 consecutive AMI survivors (≤40 years) in this prospective multicentre study and investigated the influence of the familial combined hypercholesterolaemia phenotype and a corresponding multimarker panel of different lipid fractions on cardiovascular outcome., Results: Total cholesterol, non-HDL cholesterol, remnant cholesterol and Apo B lipoprotein were significantly higher in patients experiencing MACE as compared to those who did not. The familial combined hypercholesterolaemia phenotype was associated with an unfavourable cardiovascular outcome even after adjustment for potential cofounders (adjusted HR 3.04,95% CI, 1.26-7.34, P = 0.013). Remnant cholesterol revealed the strongest association with MACE (adj.HR 1.94, 95%CI. 1.30-2.99, P = 0.001). Interestingly LDL and HDL revealed no significant impact on cardiovascular outcome in this study cohort., Conclusion: Non-HDL and remnant cholesterol are strongly associated with an unfavourable outcome in patients with premature myocardial infarction and might be the preferred treatment target for lipid-lowering therapy., (© 2018 Stichting European Society for Clinical Investigation Journal Foundation.)

Published
2018
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25. Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

Author

Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, and Steinwender C

Subjects
Adrenergic beta-Antagonists adverse effects, Anesthesia, General, Arrhythmias, Cardiac mortality, Arrhythmias, Cardiac prevention & control, Bradycardia chemically induced, Cardiovascular Diseases chemically induced, Cardiovascular Diseases mortality, Cardiovascular Surgical Procedures adverse effects, Cardiovascular Surgical Procedures mortality, Cause of Death, Cerebrovascular Disorders mortality, Cerebrovascular Disorders prevention & control, Humans, Hypotension chemically induced, Hypotension mortality, Hypotension prevention & control, Myocardial Infarction mortality, Myocardial Infarction prevention & control, Myocardial Ischemia mortality, Myocardial Ischemia prevention & control, Postoperative Complications mortality, Randomized Controlled Trials as Topic, Surgical Procedures, Operative mortality, Adrenergic beta-Antagonists therapeutic use, Cardiovascular Diseases prevention & control, Postoperative Complications prevention & control, Surgical Procedures, Operative adverse effects
Abstract

Background: Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue., Objectives: The objective of this review was to systematically analyse the effects of perioperatively administered beta-blockers for prevention of surgery-related mortality and morbidity in patients undergoing any type of surgery while under general anaesthesia., Search Methods: We identified trials by searching the following databases from the date of their inception until June 2013: MEDLINE, Embase , the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File, Science Citation Index Expanded, Life Sciences Collection, Global Health and PASCAL. In addition, we searched online resources to identify grey literature., Selection Criteria: We included randomized controlled trials if participants were randomly assigned to a beta-blocker group or a control group (standard care or placebo). Surgery (any type) had to be performed with all or at least a significant proportion of participants under general anaesthesia., Data Collection and Analysis: Two review authors independently extracted data from all studies. In cases of disagreement, we reassessed the respective studies to reach consensus. We computed summary estimates in the absence of significant clinical heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and mean differences (MDs) were used for continuous outcomes. We performed subgroup analyses for various potential effect modifiers., Main Results: We included 88 randomized controlled trials with 19,161 participants. Six studies (7%) met the highest methodological quality criteria (studies with overall low risk of bias: adequate sequence generation, adequate allocation concealment, double/triple-blinded design with a placebo group, intention-to-treat analysis), whereas in the remaining trials, some form of bias was present or could not be definitively excluded (studies with overall unclear or high risk of bias). Outcomes were evaluated separately for cardiac and non-cardiac surgery.CARDIAC SURGERY (53 trials)We found no clear evidence of an effect of beta-blockers on the following outcomes.• All-cause mortality: RR 0.73, 95% CI 0.35 to 1.52, 3783 participants, moderate quality evidence.• Acute myocardial infarction (AMI): RR 1.04, 95% CI 0.71 to 1.51, 3553 participants, moderate quality evidence.• Myocardial ischaemia: RR 0.51, 95% CI 0.25 to 1.05, 166 participants, low quality evidence.• Cerebrovascular events: RR 1.52, 95% CI 0.58 to 4.02, 1400 participants, low quality evidence.• Hypotension: RR 1.54, 95% CI 0.67 to 3.51, 558 participants, low quality evidence.• Bradycardia: RR 1.61, 95% CI 0.97 to 2.66, 660 participants, low quality evidence.• Congestive heart failure: RR 0.22, 95% CI 0.04 to 1.34, 311 participants, low quality evidence.Beta-blockers significantly reduced the occurrence of the following endpoints.• Ventricular arrhythmias: RR 0.37, 95% CI 0.24 to 0.58, number needed to treat for an additional beneficial outcome (NNTB) 29, 2292 participants, moderate quality evidence.• Supraventricular arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB five, 6420 participants, high quality evidence.• On average, beta-blockers reduced length of hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450 participants, low quality evidence).NON-CARDIAC SURGERY (35 trials)Beta-blockers significantly increased the occurrence of the following adverse events.• All-cause mortality: RR 1.25, 95% CI 1.00 to 1.57, 11,413 participants, low quality of evidence, number needed to treat for an additional harmful outcome (NNTH) 167.• Hypotension: RR 1.50, 95% CI 1.38 to 1.64, NNTH 16, 10,947 participants, high quality evidence.• Bradycardia: RR 2.23, 95% CI 1.48 to 3.36, NNTH 21, 11,033 participants, moderate quality evidence.We found a potential increase in the occurrence of the following outcomes with the use of beta-blockers.• Cerebrovascular events: RR 1.59, 95% CI 0.93 to 2.71, 9150 participants, low quality evidence.Whereas no clear evidence of an effect was found when all studies were analysed, restricting the meta-analysis to low risk of bias studies revealed a significant increase in cerebrovascular events with the use of beta-blockers: RR 2.09, 95% CI 1.14 to 3.82, NNTH 265, 8648 participants.Beta-blockers significantly reduced the occurrence of the following endpoints.• AMI: RR 0.73, 95% CI 0.61 to 0.87, NNTB 76, 10,958 participants, high quality evidence.• Myocardial ischaemia: RR 0.51, 95% CI 0.34 to 0.77, NNTB nine, 978 participants, moderate quality evidence.• Supraventricular arrhythmias: RR 0.73, 95% CI 0.57 to 0.94, NNTB 112, 8744 participants, high quality evidence.We found no clear evidence of an effect of beta-blockers on the following outcomes.• Ventricular arrhythmias: RR 0.68, 95% CI 0.31 to 1.49, 476 participants, moderate quality evidence.• Congestive heart failure: RR 1.18, 95% CI 0.94 to 1.48, 9173 participants, moderate quality evidence.• Length of hospital stay: mean difference -0.45 days, 95% CI -1.75 to 0.84, 551 participants, low quality evidence., Authors' Conclusions: According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery, as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence shows an association of beta-blockers with increased all-cause mortality. Data from low risk of bias trials further suggests an increase in stroke rate with the use of beta-blockers. As the quality of evidence is still low to moderate, more evidence is needed before a definitive conclusion can be drawn. The substantial reduction in supraventricular arrhythmias and AMI in this setting seems to be offset by the potential increase in mortality and stroke.

Published
2018
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26. Long-term outcome and risk assessment in premature acute myocardial infarction: A 10-year follow-up study.

Author

Winter MP, Blessberger H, Alimohammadi A, Pavo N, Huber K, Wojta J, Lang IM, Wiesbauer F, and Goliasch G

Subjects
Adult, Biomarkers blood, Cardiac Catheterization mortality, Case-Control Studies, Cause of Death trends, Female, Follow-Up Studies, Humans, Male, Myocardial Infarction mortality, Prospective Studies, Recurrence, Retrospective Studies, Risk Assessment methods, Time Factors, Treatment Outcome, Cardiac Catheterization trends, Myocardial Infarction diagnosis, Myocardial Infarction therapy
Abstract

Background: Premature acute myocardial infarction (AMI) is a rare disease carrying significant morbidity and mortality. Existing data on outcome in these patients is based on retrospective analysis of angiographic reports or refer to time periods with incomparable treatment regimes, making them unusable for risk assessment in times of widespread use of reperfusion therapy. Aim of this study was to assess the outcome of premature AMI in a prospectively recruited study population enrolled in the times of modern reperfusion therapy., Methods: We included 102 consecutive AMI survivors (≤40years) in this prospective multicentre study. Outcome was assessed via retrieval query of the Austrian Death Registry and the centralized patient management system of Vienna., Results: During a median follow up time of 10.3years (IQR:8.9-11.1), 23% of all patients experienced MACE, of those 6% died, 17% experienced re-AMI and 5% patients an ischemic stroke. Furthermore, forty patients underwent cardiac re-catheterization and twenty-five needed recurrent revascularization. MACE were associated among the classic cardiovascular risk factors with elevated levels of HbA1c (adj. HR 1.32; 95%CI 1.06-1.64; P=0.012), total cholesterol (adj. HR 2.16; 95%CI 1.27-3.48; P=0.004), and c-reactive protein (adj. HR 1.67; 95%CI 1.29-2.17; P=0-003) for an increase of 1-standard deviation., Conclusion: Although myocardial re-infarction was the driving force of morbidity in premature myocardial infarction, we observed an excellent long-term survival opposed to previous reports. We found that persistence risk factors rather than the clinical risk profile at baseline influences the outcome in these patients, emphasizing the importance of secondary prevention in young patients after AMI., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Published
2017
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27. Soluble galectin-3 is associated with premature myocardial infarction.

Author

Winter MP, Wiesbauer F, Alimohammadi A, Blessberger H, Pavo N, Schillinger M, Huber K, Wojta J, Lang IM, Maurer G, and Goliasch G

Subjects
Adult, Biomarkers, Blood Proteins, Case-Control Studies, Cholesterol blood, Cholesterol, HDL blood, Cholesterol, LDL blood, Comorbidity, Diabetes Mellitus epidemiology, Dyslipidemias epidemiology, Female, Galectins, Humans, Hypertension epidemiology, Leukocyte Count, Lipase blood, Logistic Models, Male, Myocardial Infarction epidemiology, Smoking epidemiology, Dyslipidemias blood, Galectin 3 blood, Myocardial Infarction blood, Plaque, Atherosclerotic blood
Abstract

Background: Inflammatory responses are pivotal in the initiation and development of premature atherosclerotic lesions. Galectin-3 represents a valuable biomarker for both progression and destabilization of atherosclerotic lesions. This study aims to assess the involvement of galectin-3 in premature myocardial infarction., Design: In this multicentre case-control study, we assessed circulating galectin-3 levels in 144 patients comprising 72 consecutive survivors of acute myocardial infarction (≤ 40 years) and 72 hospital controls frequency matched for age, gender and centre., Results: Patients with acute myocardial infarction showed significantly higher galectin-3 levels as compared to controls in the acute phase of acute myocardial infarction (2552 ± 1992 vs. 1666 ± 829 pg/mL; P < 0·001) as well as in the stable phase 1 year after the index event (3692 ± 1774 vs. 1666 ± 829 pg/mL; P < 0·001). Circulating galectin-3 was significantly and independently associated with premature myocardial infarction in the logistic regression analysis (acute phase: adj. OR per 1-SD change 2·03, 95% CI 1·30-3·19; P = 0·002; stable phase: adj. OR of 6·54 (95% CI 2·56-16·68; P < 0·001). Moreover, we observed a significant correlation between circulating galectin-3 and leucocyte count (r = 0·35, P < 0·001), non-HDL cholesterol (r = 0·23, P = 0·014) and HDL cholesterol (r = -0·29, P = 0·002)., Conclusion: We demonstrated that elevated levels of circulating galectin-3 are strongly associated with premature myocardial infarction. Galectin-3 might serve as link between dyslipidaemia as driving force of plaque formation with inflammation as initiator of plaque rupture in patients with premature acute myocardial infarction., (© 2016 Stichting European Society for Clinical Investigation Journal Foundation.)

Published
2016
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28. Premature myocardial infarction is strongly associated with increased levels of remnant cholesterol.

Author

Goliasch G, Wiesbauer F, Blessberger H, Demyanets S, Wojta J, Huber K, Maurer G, Schillinger M, and Speidl WS

Subjects
Adult, Biomarkers blood, Female, Humans, Lipoproteins blood, Male, Risk Factors, Cholesterol blood, Myocardial Infarction blood
Abstract

Background: Remnant cholesterol has been defined as the cholesterol present in triglyceride-rich remnant lipoproteins. Elevated levels of remnant cholesterol have been associated with increased cardiovascular risk. Acute myocardial infarction (AMI) in very young individuals (≤40 years) represents a rare disease with a typical risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride-rich lipoproteins., Objective: The aim of this study was to investigate the role of remnant cholesterol in premature AMI., Methods: We prospectively enrolled 302 patients into our multicenter case-control study comprising 102 consecutive myocardial infarction survivors (≤40 years) and 200 hospital controls. Myocardial infarction patients were frequency matched for age, gender, and center. Remnant cholesterol was calculated from standard lipid parameters., Results: Remnant cholesterol was 1.7-fold higher in premature AMI patients compared with controls (61.1 ± 36.8 vs 35.8 ± 16.8 mg/dL; P < .001). Remnant cholesterol was the lipid fraction most strongly associated with premature myocardial infarction (odds ratio 3.87; 95% confidence interval 2.26-6.64; P < .001) for an increase of 1-standard deviation. This observation was independent from clinical risk factors and plasma lipid levels., Conclusions: Remnant cholesterol is strongly associated with premature myocardial infarction, can be easily calculated, and might serve as a new potent risk marker in this young patient population., (Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.)

Published
2015
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29. Impaired antioxidant HDL function is associated with premature myocardial infarction.

Author

Distelmaier K, Wiesbauer F, Blessberger H, Oravec S, Schrutka L, Binder C, Dostal E, Schillinger M, Wojta J, Lang IM, Maurer G, Huber K, and Goliasch G

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Antioxidants metabolism, Case-Control Studies, Cholesterol, HDL metabolism, Female, Humans, Male, Middle Aged, Risk Factors, Young Adult, Antioxidants physiology, Cholesterol, HDL physiology, Coronary Artery Disease complications, Myocardial Infarction etiology
Abstract

Background: There is growing evidence that the predictive value of HDL cholesterol levels for cardiovascular risk stratification is limited in patients with coronary artery disease (CAD). HDL function seems to be a more sensitive surrogate of cardiovascular risk estimation than simple serum levels. Therefore, we aimed to assess whether impaired antioxidant HDL function is involved in the development of premature acute myocardial infarction (AMI)., Methods: In this multicentre case-control study, we compared the antioxidant function of HDL, measured by the HDL inflammatory index (HII), and HDL particle size in 184 patients comprising 92 patients with AMI at a very young age (≤40 years of age) and 92 age- and gender-matched controls., Results: Antioxidant capacities of HDL were significantly impaired in the acute phase of AMI (HII of 1·50 [IQR 1·10-1·74] vs. 0·56 [IQR 0·41-0·86] in controls, P < 0·001 as well as in the chronic stable phase 1 year after the event (HII of 0·85 [IQR 0·72-1·03] vs. 0·56 [IQR 0·41-0·86], P < 0·001) compared to controls. Moreover, HDL function in the stable phase remained significantly associated with premature MI in adjusted logistic regression analysis with an OR of 2·24 per SD increase of HII (95% CI 1·28-3·91; P = 0·005). Analyses of HDL size revealed a significant correlation between all HDL subfractions and HDL function in controls, whereas this correlation was lost for large and intermediate HDL in AMI patients., Conclusion: Impaired antioxidant function of HDL is independently associated with the development of premature AMI. The maintenance of HDL function might evolve into a significant therapeutic target, especially in patients with premature CAD., (© 2015 Stichting European Society for Clinical Investigation Journal Foundation.)

Published
2015
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31. Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

Author

Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, and Steinwender C

Subjects
Adrenergic beta-Antagonists adverse effects, Anesthesia, General, Arrhythmias, Cardiac mortality, Arrhythmias, Cardiac prevention & control, Cardiovascular Diseases chemically induced, Cardiovascular Diseases mortality, Cardiovascular Surgical Procedures adverse effects, Cardiovascular Surgical Procedures mortality, Cause of Death, Cerebrovascular Disorders mortality, Cerebrovascular Disorders prevention & control, Humans, Hypotension chemically induced, Hypotension mortality, Hypotension prevention & control, Myocardial Infarction mortality, Myocardial Infarction prevention & control, Myocardial Ischemia mortality, Myocardial Ischemia prevention & control, Postoperative Complications mortality, Randomized Controlled Trials as Topic, Surgical Procedures, Operative mortality, Adrenergic beta-Antagonists therapeutic use, Cardiovascular Diseases prevention & control, Postoperative Complications prevention & control, Surgical Procedures, Operative adverse effects
Abstract

Background: Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue., Objectives: The objective of this review was to systematically analyse the effects of perioperatively administered beta-blockers for prevention of surgery-related mortality and morbidity in patients undergoing any type of surgery while under general anaesthesia., Search Methods: We identified trials by searching the following databases from the date of their inception until June 2013: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File, Science Citation Index Expanded, Life Sciences Collection, Global Health and PASCAL. In addition, we searched online resources to identify grey literature., Selection Criteria: We included randomized controlled trials if participants were randomly assigned to a beta-blocker group or a control group (standard care or placebo). Surgery (any type) had to be performed with all or at least a significant proportion of participants under general anaesthesia., Data Collection and Analysis: Two review authors independently extracted data from all studies. In cases of disagreement, we reassessed the respective studies to reach consensus. We computed summary estimates in the absence of significant clinical heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and mean differences (MDs) were used for continuous outcomes. We performed subgroup analyses for various potential effect modifiers., Main Results: We included 89 randomized controlled trials with 19,211 participants. Six studies (7%) met the highest methodological quality criteria (studies with overall low risk of bias: adequate sequence generation, adequate allocation concealment, double/triple-blinded design with a placebo group, intention-to-treat analysis), whereas in the remaining trials, some form of bias was present or could not be definitively excluded (studies with overall unclear or high risk of bias). Outcomes were evaluated separately for cardiac and non-cardiac surgery. CARDIAC SURGERY (53 trials)We found no clear evidence of an effect of beta-blockers on the following outcomes.• All-cause mortality: RR 0.73, 95% CI 0.35 to 1.52, 3783 participants, moderate quality of evidence.• Acute myocardial infarction (AMI): RR 1.04, 95% CI 0.71 to 1.51, 3553 participants, moderate quality of evidence.• Myocardial ischaemia: RR 0.51, 95% CI 0.25 to 1.05, 166 participants, low quality of evidence.• Cerebrovascular events: RR 1.52, 95% CI 0.58 to 4.02, 1400 participants, low quality of evidence.• Hypotension: RR 1.54, 95% CI 0.67 to 3.51, 558 participants, low quality of evidence.• Bradycardia: RR 1.61, 95% CI 0.97 to 2.66, 660 participants, low quality of evidence.• Congestive heart failure: RR 0.22, 95% CI 0.04 to 1.34, 311 participants, low quality of evidence.Beta-blockers significantly reduced the occurrence of the following endpoints.• Ventricular arrhythmias: RR 0.37, 95% CI 0.24 to 0.58, number needed to treat for an additional beneficial outcome (NNTB) 29, 2292 participants, moderate quality of evidence.• Supraventricular arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB six, 6420 participants, high quality of evidence.• On average, beta-blockers reduced length of hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450 participants, low quality of evidence). NON-CARDIAC SURGERY (36 trials)We found a potential increase in the occurrence of the following outcomes with the use of beta-blockers.• All-cause mortality: RR 1.24, 95% CI 0.99 to 1.54, 11,463 participants, low quality of evidence.Whereas no clear evidence of an effect was noted when all studies were analysed, restricting the meta-analysis to low risk of bias studies revealed a significant increase in all-cause mortality with the use of beta-blockers: RR 1.27, 95% CI 1.01 to 1.59, number needed to treat for an additional harmful outcome (NNTH) 189, 10,845 participants.• Cerebrovascular events: RR 1.59, 95% CI 0.93 to 2.71, 9150 participants, low quality of evidence.Whereas no clear evidence of an effect was found when all studies were analysed, restricting the meta-analysis to low risk of bias studies revealed a significant increase in cerebrovascular events with the use of beta-blockers: RR 2.09, 95% CI 1.14 to 3.82, NNTH 255, 8648 participants.Beta-blockers significantly reduced the occurrence of the following endpoints.• AMI: RR 0.73, 95% CI 0.61 to 0.87, NNTB 72, 10,958 participants, high quality of evidence.• Myocardial ischaemia: RR 0.43, 95% CI 0.27 to 0.70, NNTB seven, 1028 participants, moderate quality of evidence.• Supraventricular arrhythmias: RR 0.72, 95% CI 0.56 to 0.92, NNTB 111, 8794 participants, high quality of evidence.Beta-blockers significantly increased the occurrence of the following adverse events.• Hypotension: RR 1.50, 95% CI 1.38 to 1.64, NNTH 15, 10,947 participants, high quality of evidence.• Bradycardia: RR 2.24, 95% CI 1.49 to 3.35, NNTH 18, 11,083 participants, moderate quality of evidence.We found no clear evidence of an effect of beta-blockers on the following outcomes.• Ventricular arrhythmias: RR 0.64, 95% CI 0.30 to 1.33, 526 participants, moderate quality of evidence.• Congestive heart failure: RR 1.17, 95% CI 0.93 to 1.47, 9223 participants, moderate quality of evidence.• Length of hospital stay: mean difference -0.27 days, 95% CI -1.29 to 0.75, 601 participants, low quality of evidence., Authors' Conclusions: According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery , as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence from low risk of bias trials shows an increase in all-cause mortality and stroke with the use of beta-blockers. As the quality of evidence is still low to moderate, more evidence is needed before a definitive conclusion can be drawn. The substantial reduction in supraventricular arrhythmias and AMI in this setting seems to be offset by the potential increase in mortality and stroke.

Published
2014
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32. Left atrial diameter and survival among renal allograft recipients.

Author

Kainz A, Goliasch G, Wiesbauer F, Binder T, Maurer G, Nesser HJ, Mascherbauer R, Ebner C, Kramar R, Wilflingseder J, and Oberbauer R

Subjects
Adult, Aged, Allografts, Austria, Cardiomegaly complications, Cardiomegaly mortality, Cause of Death, Chi-Square Distribution, Female, Graft Survival, Humans, Kaplan-Meier Estimate, Kidney Failure, Chronic complications, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic mortality, Life Expectancy, Male, Middle Aged, Multivariate Analysis, Patient Selection, Predictive Value of Tests, Proportional Hazards Models, Registries, Risk Factors, Time Factors, Treatment Outcome, Ultrasonography, Cardiomegaly diagnostic imaging, Heart Atria diagnostic imaging, Kidney Failure, Chronic surgery, Kidney Transplantation adverse effects, Kidney Transplantation mortality
Abstract

Background and Objectives: Sequential echocardiography is routinely performed in patients with ESRD listed for transplantation. The benefit of this labor- and time-intensive measure, however, remains unclear. Thus, this study elucidated the various obtained routine echocardiography parameters that best predicted mortality and graft survival after renal transplantation., Design, Setting, Participants, & Measurements: This study investigated 553 first renal transplant recipients listed in the Austrian Dialysis and Transplant Registry between 1992 and 2011 who had echocardiographic analysis at transplantation and survived at least 1 year. Cox proportional hazards models with the purposeful selection algorithms for covariables were used to identify predictors of mortality and graft loss. A Fine and Gray model was used to evaluate cause-specific death., Results: During a median follow-up of 7.14 years, 81 patients died, and 59 patients experienced graft loss after the first year. The Kaplan-Meier analysis showed that 85% of patients with a left atrial diameter below the median of 53 mm were alive 10 years after transplantation, whereas only 70% of those patients with a left atrial diameter equal to or above the median had survived (P<0.001). In the multivariable model, left atrial diameter (per millimeter) independently predicted overall mortality (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.08; P<0.001) and cause-specific cardiac death (hazard ratio, 1.04; 95% confidence interval, 1.00 to 1.08; P=0.04). Functional graft loss was predicted by the right atrial diameter (hazard ratio, 1.04; 95% confidence interval, 1.02 to 1.07; P=0.001)., Conclusion: The left atrial diameter determined at transplantation predicted overall and cardiac mortality. Patients with widely enlarged left atria exhibit a considerably reduced life expectancy. It remains to be determined, however, whether renal transplantation is futile in these patients.

Published
2013
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33. Relative importance of different lipid risk factors for the development of myocardial infarction at a very young age (≤ 40 years of age).

Author

Goliasch G, Oravec S, Blessberger H, Dostal E, Hoke M, Wojta J, Schillinger M, Huber K, Maurer G, and Wiesbauer F

Subjects
Adolescent, Adult, Age Factors, Case-Control Studies, Child, Child, Preschool, Female, Humans, Infant, Male, Prospective Studies, Risk Factors, Young Adult, Cholesterol, HDL blood, Cholesterol, LDL blood, Myocardial Infarction blood
Abstract

Background: Low-density lipoprotein (LDL) cholesterol lowering has been established as one of the principal targets in preventive cardiology. Recently, assessment of LDL particle size and number as well as other lipid moieties has been presented as a more reliable method to quantify atherogenicity of the lipoprotein fractions. Thus, it was our aim to assess the influence of different lipoprotein fractions on premature myocardial infarction (≤ 40 years of age)., Methods and Results: We enrolled 302 patients into our multicentre case-control study, including 102 patients with myocardial infarction and 200 age-, gender- and centre-matched controls. The LDL and HDL Lipoprint System were used for lipid subfraction quantification. The lipid risk factors most strongly associated with premature acute myocardial infarction (AMI) in the adjusted model were non-HDL C (OR 5·02, 95% CI 2·75-9·15, P-value = 0·001), LDL-C (OR 4·35, 95% CI 2·5-7·57, P-value = 0·001), VLDL-C (OR 3·66, 95% CI 2·14-6·28, P-value = 0·001), large IDL-C (OR 3·15, 95% CI 1·94-5·12, P-value = 0·001), large LDL-C (OR 3·67, 95% CI 2·19-6·15, P-value = 0·001) and intermediate LDL-C (OR 1·96, 95% CI 1·25-3·06, P-value = 0·003). In contrast, small dense LDL was not significantly associated with premature myocardial infarction., Conclusion: Non-HDL cholesterol is most strongly associated with premature coronary artery disease and could serve as preferred risk predictor and therapeutic target in this young patient population (≤ 40 years). Besides, VLDL, LDL-C, large LDL, intermediate LDL and large IDL were significantly associated with premature myocardial infarction. Furthermore, our data suggest that risk prediction using small dense LDL particles might not be useful in young AMI survivors., (© 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.)

Published
2012
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34. Premature myocardial infarction is associated with low serum levels of Wnt-1.

Author

Goliasch G, Wiesbauer F, Kastl SP, Katsaros KM, Blessberger H, Maurer G, Schillinger M, Huber K, Wojta J, and Speidl WS

Subjects
Adult, Female, Follow-Up Studies, Humans, Male, Wnt Signaling Pathway, Intercellular Signaling Peptides and Proteins blood, Myocardial Infarction blood, Wnt1 Protein blood
Abstract

Objective: Besides its effects on glucose and lipid metabolism, the Wnt pathway has been increasingly implicated in the regulation of proliferation, migration and survival of vascular cells. In addition, defective Wnt signaling has been identified in a family with autosomal dominant early coronary artery disease. The aim of this study was to investigate whether premature coronary artery disease is associated with features of decreased Wnt signaling., Methods and Results: We prospectively enrolled 100 consecutive young survivors of myocardial infarction (MI≤40 years of age) from two high-volume cardiac catheterization centers and 100 sex and age matched hospital controls. We determined serum levels of Wnt-1 and its antagonist Dkk-1 by ELISA. MI patients showed significantly lower Wnt-1 levels as compared to controls (151 ng/mL, IQR 38-473 ng/mL vs. 233 ng/mL, IQR 62-1756; p<0.005) whereas Dkk-1 was not different at baseline. Wnt-1 levels remained stable over time, whereas Dkk-1 significantly increased at one-year follow-up from 3557, IQR 2306-5810 pg/mL to 4973, IQR 3293-7093 pg/mL (p<0.001). In the stable phase of the disease, Wnt-1 levels were lower (p<0.005) and Dkk-1 levels were significantly higher (p<0.001) as compared to controls. Wnt-1 at follow-up was associated with glucose, HbA1c, non-HDL-, HDL-cholesterol and triglyceride levels but no other features of the metabolic syndrome., Conclusion: This study establishes an association between low Wnt-1 and high Dkk-1 serum levels and premature myocardial infarction. Wnt-1 is associated with markers of glucose and lipid metabolism. Further research elucidating the role of Wnt pathways in premature coronary artery disease and metabolic syndrome is warranted., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Published
2012
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35. High soluble Fas and soluble Fas Ligand serum levels before stent implantation are protective against restenosis.

Author

Katsaros KM, Wiesbauer F, Speidl WS, Kastl SP, Huber K, Zorn G, Niessner A, Glogar D, Maurer G, and Wojta J

Subjects
Aged, Biomarkers blood, Coronary Angiography, Coronary Restenosis etiology, Fas Ligand Protein blood, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Stents adverse effects, fas Receptor blood, Angioplasty, Coronary Disease therapy, Coronary Restenosis diagnosis, Postoperative Complications
Abstract

Percutaneous coronary intervention (PCI) represents the most important treatment of coronary artery stenosis today. But instent restenosis (ISR) is a limitation for the outcome. Fas and Fas Ligand have been implicated in apoptosis and vessel wall inflammation. Their role in ISR is not known so far. In this prospective study we studied 137 patients with stable coronary artery disease who underwent elective PCI. Blood samples were taken directly before and 24 hours after PCI. Soluble (s)Fas and sFas Ligand serum levels were measured by ELISA. Restenosis was evaluated six to eight months later either by coronary angiography or by exercise testing. During the follow-up period, 18 patients (13%) developed ISR. At baseline, patients with ISR had significantly lower median sFas, as well as sFas Ligand levels compared to patients without ISR (sFAS: ISR 492 pg/ml, no ISR 967 pg/ml, p=0.014; sFAS Ligand: ISR: 26 pg/ml, no ISR: 42 pg/ml, p=0.001). After PCI median sFas levels significantly decreased in patients with ISR compared to patients without ISR [ISR: -152 pg/ml (IQR -36 to -227), no ISR: -38 pg/ml (IQR -173 to +150 pg/ml), p=0.03]. sFas Ligand levels after PCI significantly increased in ISR patients compared to patients without ISR [ISR: 14 pg/ml (IQR -3 to +26 pg/ml), no ISR -6 pg/ml (IQR -22 to +21 pg/ml), p=0.014]. In conclusion, sFas and sFas Ligand seem to be associated with the development of ISR. Determination of serum levels before and after PCI might help identifying patients at higher risk of ISR.

Published
2011
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36. Markers of bone metabolism in premature myocardial infarction (≤ 40 years of age).

Author

Goliasch G, Blessberger H, Azar D, Heinze G, Wojta J, Bieglmayer C, Wagner O, Schillinger M, Huber K, Maurer G, Haas M, and Wiesbauer F

Subjects
Adult, Biomarkers blood, Case-Control Studies, Female, Humans, Logistic Models, Male, Time Factors, Vitamin D analogs & derivatives, Vitamin D blood, Bone and Bones metabolism, Myocardial Infarction blood
Abstract

Introduction: Acute myocardial infarction (AMI) at young age is a rare disease with a poor prognosis. Bone metabolism parameters such as 1,25 (OH)₂ vitamin D₃, 25 (OH) vitamin D₃ and osteocalcin have been recently implicated in the development of coronary heart disease (CHD). We evaluated the role of these serum markers in a study population of very young AMI survivors (≤ 40 years)., Methods and Results: We prospectively enrolled 302 subjects into our multi-center case control study, including 102 young myocardial infarction patients (≤ 40 years) and 200 control subjects who were frequency-matched on gender and age in an approximate 2:1 ratio per case patient. In the adjusted logistic regression analysis, we used baseline laboratory measurements for the first analysis (acute phase analysis) and measurements from one-year follow-up visits (stable phase analysis). In both, elevated levels of 25 (OH) vitamin D₃ (acute phase: OR per IQR 2.02, 95% CI 1.13-3.58, p = 0.017; stable phase: OR 4.07, 95% CI 1.8-9.21, p = 0.001) and 1,25 (OH)₂ vitamin D₃ (acute phase: OR 2.82, 95% CI 1.7-4.7, p < 0.001; stable phase: OR 4.57, 95% CI 2.31-9.05, p < 0.001) were associated with premature AMI. Conversely, osteocalcin was inversely associated with premature myocardial infarction (acute phase: OR 0.53, 95% CI 0.28-1.03, p = 0.059; stable phase: OR 0.26, 95% CI 0.12-0.6, p < 0.001). The observed associations were independent of the acute phase of myocardial infarction., Conclusion: In our study, elevated levels of 25 (OH) vitamin D₃ and 1,25 (OH)₂ vitamin D₃, as well as decreased levels of osteocalcin were associated with myocardial infarction in very young patients. The precise mechanism and implications of these findings will have to be elucidated in future studies., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Published
2011
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37. The effect of p22-PHOX (CYBA) polymorphisms on premature coronary artery disease (≤ 40 years of age).

Author

Goliasch G, Wiesbauer F, Grafl A, Ponweiser E, Blessberger H, Tentzeris I, Wojta J, Schillinger M, Huber K, Maurer G, Mannhalter C, and Sunder-Plassmann R

Subjects
Adult, Alleles, Catheterization, Female, Homozygote, Humans, Male, Models, Statistical, Myocardial Infarction genetics, Polymerase Chain Reaction, Reactive Oxygen Species, Regression Analysis, Coronary Artery Disease genetics, NADPH Oxidases genetics, Polymorphism, Genetic
Abstract

Acute myocardial infarction at a young age is associated with high morbidity and long-term mortality. The NADPH oxidase system as a main source of reactive oxygen species in vascular cells has been implicated in development and progression of coronary artery disease (CAD). In our study, we investigated the effect of polymorphisms in the p22-PHOX (CYBA) gene on CAD in young patients (≤ 40 years). We prospectively recruited 302 subjects into our multi-centre case control study, including 102 young myocardial infarction patients (≤ 40 years) from two high-volume cardiac catheterisation hospitals and frequency-matched them on age, gender, and center to 200 hospital controls in an approximate 2:1 ratio per case patient. The homozygote c.-930A>G promoter polymorphism was significantly more prevalent in the controls than in the infarction patients. In the adjusted logistic regression analysis, we detected a protective effect of the c.-930A>G promoter polymorphism against premature myocardial infarction. Using a log-additive/per-allele model, we detected an unadjusted odds ratio (OR) of 0.63 (95% confidence interval [CI] 0.45-0.9, p-value 0.011). In the adjusted model the association was more pronounced with an OR of 0.5 (95% CI 0.3-0.81, p-value 0.005). The C242T polymorphism and the 640A>G polymorphism did not differ significantly between the study groups. Furthermore we could not detect a significant effect for these polymorphisms in the logistic regression analysis. The present study suggests a protective association between the c.-930A>G promoter polymorphism in the p22-PHOX (CYBA) gene and the development of myocardial infarction in young individuals (≤ 40 years).

Published
2011
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38. Evidence of carotid atherosclerosis in orthopantomograms and the risk for future cardiovascular events.

Author

Hoke M, Schmidt B, Schillinger T, Kluger W, Wiesbauer F, Mlekusch W, Minar E, and Schillinger M

Subjects
Aged, Austria, Cardiovascular Diseases mortality, Carotid Artery Diseases complications, Carotid Artery Diseases mortality, Carotid Stenosis complications, Carotid Stenosis mortality, Chi-Square Distribution, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Ultrasonography, Doppler, Duplex, Cardiovascular Diseases etiology, Carotid Artery Diseases diagnostic imaging, Carotid Stenosis diagnostic imaging, Radiography, Panoramic
Abstract

Background: Evidence of carotid atherosclerosis can be detected in 3 to 5% of orthopantomogram (OPG) investigations. The clinical impact of these findings is unknown. We investigated the association of OPG findings of carotid atherosclerosis with the occurrence of future cardiovascular adverse events., Patients and Methods: We randomly selected 411 of 1268 participants with pre-existent cardiovascular disease from the prospective Inflammation in Carotid Arteries Risk for Arthrosclerosis Study (ICARAS) and assessed their OPGs for the presence of calcified atherosclerotic lesions or indirect signs of atherosclerosis, such as surgical clips or intravascular stents. The degree of carotid stenosis was measured by duplex ultrasound investigations. Patients were then followed for median 39 months (interquartile range 33 to 44 months) for the occurrence of major adverse cardiovascular events (MACE) including myocardial infarction, coronary revascularisation, stroke and death., Results: We found no statistically significant association between the presence of carotid atherosclerosis detected on OPGs and the presence of a significant carotid stenosis (left carotid artery kappa=0.08; right carotid artery kappa=0.12), or the degree of carotid stenosis (P=0.20). Furthermore, the presence of OPG signs of carotid atherosclerosis was not statistically significant associated with future MACE (adjusted hazard ratio 0.92, 95% confidence interval 0.59 to 1.42; P=0.70)., Conclusions: Evidence of carotid plaque revealed by OPGs in patients with previously known cardiovascular disease is no useful prognostic marker for MACE. Detection of carotid atherosclerosis by OPGs in these patients therefore has no clinical consequence.

Published
2010
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39. Electrical optimization of cardiac resynchronization in chronic heart failure is associated with improved clinical long-term outcome.

Author

Adlbrecht C, Hülsmann M, Gwechenberger M, Graf S, Wiesbauer F, Strunk G, Khazen C, Brodnjak I, Neuhold S, Binder T, Maurer G, and Pacher R

Subjects
Adrenergic beta-Antagonists administration & dosage, Aged, Chronic Disease, Cohort Studies, Echocardiography, Female, Heart Failure mortality, Hospital Mortality, Hospitalization statistics & numerical data, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Regression Analysis, Retrospective Studies, Survival Analysis, Cardiac Pacing, Artificial methods, Heart Failure therapy
Abstract

Background: Cardiac resynchronization therapy (CRT) is an established treatment option for symptomatic chronic heart failure (CHF) patients with pharmacological baseline therapy, but not all patients benefit from device therapy. One reason for this may be inadequate device settings. In real-world practice, echocardiographic evaluation of atrioventricular (AV) delay is not performed in a high proportion of patients, as the effect of electrical optimization of CRT is an issue open for investigation., Materials and Methods: We performed a retrospective observational study analysing the effect of AV-interval evaluation with echocardiography on long-term [32 (23?43) months] clinical outcome in 205 CHF patients. A stepwise Cox regression model including a co-morbidity score, failed AV-interval evaluation, satisfactory device function after the first implantation attempt, failure to reach 100% of the recommended renin-angiotensin system inhibitor and beta-blocker dose at follow-up and CRT device implantation compared with CRT in combination with an implanted cardioverter defibrillator (ICD) was applied., Results: In the total study cohort, 124 (60.5%) patients had reached the primary combined endpoint death or cardiac hospitalization and 59 (28.8%) had died. Cox regression analysis revealed that failed AV-interval evaluation [HR = 1.72 (1.19-2.49), P = 0.004] non-optimized CHF pharmacotherapy dosages [HR = 2.12 (1.32-3.42), P = 0.002], the presence of a CRT/ICD combination device [HR = 1.87 (1.28-2.71), P = 0.001] and satisfactory device function after the first implantation attempt [HR = 0.44 (0.25-0.77), P = 0.004] were associated with the primary endpoint., Conclusion: Echocardiographic evaluation of the AV-interval in patients with CRT was independently associated with improved clinical outcome, impacting on daily clinical practice of HF patient care.

Published
2010
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40. D-dimer testing in the diagnosis of transfemoral pseudoaneurysm after percutaneous transluminal procedures.

Author

Hoke M, Koppensteiner R, Schillinger M, Haumer M, Minar E, Wiesbauer F, Huber CD, and Mlekusch W

Subjects
Aged, Aneurysm, False blood, Aneurysm, False etiology, Aneurysm, False physiopathology, Biomarkers blood, Blood Flow Velocity, Case-Control Studies, Chi-Square Distribution, Female, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Platelet Count, Predictive Value of Tests, Prospective Studies, Regional Blood Flow, Risk Assessment, Risk Factors, Sensitivity and Specificity, Treatment Outcome, Ultrasonography, Doppler, Color, Up-Regulation, Vascular Fistula blood, Vascular Fistula etiology, Vascular Fistula physiopathology, Aneurysm, False diagnosis, Angioplasty, Balloon adverse effects, Femoral Artery, Fibrin Fibrinogen Degradation Products analysis, Peripheral Vascular Diseases therapy, Vascular Fistula diagnosis
Abstract

Objective: Pseudoaneurysms are characterized by extravascular circulation and therefore may lead to an activation of the coagulation cascade. We investigated d-dimer levels in patients with and without postcatheterization femoral pseudoaneurysms and hypothesized that d-dimer levels correlate with the presence of pseudoaneurysms at the vascular access site., Methods: Patients with clinical suspected groin pseudoaneurysms after transluminal procedures were eligible. We compared prospectively-collected laboratory values of quantitative d-dimer testing in patients with and without pseudoaneurysms as assessed by color-coded duplex sonography. Furthermore, we measured the peak systolic velocity at the arterial fistula of each pseudoaneurysm., Results: In 48 (40%) of 120 consecutive patients, a pseudoaneurysm was found. The level of d-dimer values was significantly higher in patients with postcatheterization femoral pseudoaneurysms compared with controls (1.9 microg/mL [interquartile range (IQR), 1.34-2.78 microg/mL] vs 0.8 microg/mL [IQR, 0.53-1.14 microg/mL]; P < .001). Values of d-dimer below 0.67 microg/mL have been calculated with a sensitivity of 94% (87%-100%), a specificity of 38% (27%-50%), a positive predictive value of 50% (40%-60%), a negative predictive value of 90% (82%-99%), and a likelihood ratio of 1.52 (1.25-1.85) with regard to the presence of pseudoaneurysms. We also found a significant correlation of the peak systolic velocity at the arterial fistula and increasing d-dimer levels (r = 0.98, P < .0001)., Conclusion: We found a significantly higher level of d-dimer values in patients with femoral pseudoaneurysms at the vascular access site. Therefore, d-dimer levels could be a potential serological marker in the diagnosis of pseudoaneurysms. A confirmation is warranted in a larger patient sample., (Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Published
2010
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41. Glucose control is associated with patient survival in diabetic patients after renal transplantation.

Author

Wiesbauer F, Heinze G, Regele H, Hörl WH, Schernthaner GH, Schwarz C, Kainz A, Kramar R, and Oberbauer R

Subjects
Blood Glucose drug effects, Cohort Studies, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 drug therapy, Europe, Glycated Hemoglobin metabolism, Graft Survival physiology, Homeostasis, Humans, Hypoglycemic Agents therapeutic use, Immunosuppressive Agents therapeutic use, Kidney Transplantation mortality, Kidney Transplantation pathology, Registries, Retrospective Studies, Survival Rate, Transplantation, Homologous, Treatment Failure, Treatment Outcome, Blood Glucose metabolism, Diabetes Mellitus, Type 1 blood, Diabetic Nephropathies surgery, Insulin therapeutic use, Kidney Failure, Chronic etiology, Kidney Failure, Chronic surgery, Kidney Transplantation physiology
Abstract

Introduction: The efficacy of tight glycemic control for the prevention of death and renal failure in the general diabetic population is well established. However, in diabetic renal-allograft recipients, the effect of different treatment strategies on outcomes is undetermined., Methods: We conducted a cohort study of 798 diabetic, renal-allograft recipients transplanted at the Medical University of Vienna between 1990 and 2004. We studied the influence of glucose parameters and diabetes treatment on mortality and graft loss. Marginal-structural models and multivariable Cox regression analysis were used to control for confounding., Results: Maximal glucose levels but not HbA1c were independently associated with mortality. Being in the highest quartile of maximal glucose increased the adjusted risk of death by a factor of 2.2 (P value for trend 0.009). Furthermore, in patients receiving insulin, the risk of death was increased 1.7-fold (95% confidence interval 0.9-3.1) compared with diet and 2.0-fold (95% confidence interval 1.1-3.7) compared with oral medication. Maximal glucose, HbA1c, or diabetes treatment did not influence death-censored functional graft survival., Discussion: In conclusion, maximal glucose levels and insulin treatment were independently associated with higher rates of mortality in our cohort of diabetic, renal-allograft recipients. However, graft survival was unaffected.

Published
2010
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42. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (< or =40 years of age).

Author

Wiesbauer F, Blessberger H, Azar D, Goliasch G, Wagner O, Gerhold L, Huber K, Widhalm K, Abdolvahab F, Sodeck G, Maurer G, and Schillinger M

Subjects
Adult, Age Factors, Cholesterol, LDL metabolism, Female, Humans, Hyperlipidemia, Familial Combined complications, Hyperlipidemia, Familial Combined genetics, Male, Prevalence, Prognosis, Prospective Studies, Risk Factors, Survivors, Hyperlipidemia, Familial Combined mortality, Myocardial Infarction mortality
Abstract

Aims: Myocardial infarction (MI) in very young individuals is a rare disease associated with an unfavourable prognosis. Familial-combined hyperlipidaemia (FCHL) increases the risk for MI in individuals below 60 years; however, its role in very young MI patients below 40 years is not as well established. We investigated the prevalence and impact of FCHL in these very young MI patients., Methods and Results: We prospectively enrolled 102 consecutive MI survivors (< or =40 years) from two high-volume cardiac catheterization centres. Patients were frequency-matched for age, gender, and centre to 200 hospital controls free from coronary heart disease. Myocardial infarction patients were invited to send family members for FCHL screening. Overall, 37 families were screened. Familial-combined hyperlipidaemia was diagnosed using a nomogram, which takes into account total cholesterol, triglycerides, and Apo B(100) levels. Thirty-eight acute myocardial infarction (AMI) patients (38%) and five controls (2.5%) displayed the FCHL phenotype, 21 of these MI patients sent family members for screening, and FCHL was confirmed in 16 families (76%). The FCHL phenotype was associated with a 24-fold increased adjusted risk for MI (95% CI 7.5-81, P < 0.001). Of all lipid parameters, VLDL-cholesterol, and non-HDL-cholesterol were most strongly associated with MI., Conclusions: The present study suggests that the FCHL phenotype seems to be a major risk factor for the occurrence of MI at a very young age. It remains to be determined whether this excessively increased risk can be favourably modified by therapeutic interventions.

Published
2009
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43. Elevated risk of myocardial infarction in very young immigrants from former Yugoslavia.

Author

Wiesbauer F, Blessberger H, Goliasch G, Holy EW, Pfaffenberger S, Tentzeris I, Maurer G, Huber K, Abdolvahab F, Sodeck G, Exner M, Wojta J, and Schillinger M

Subjects
Adolescent, Adult, Age Distribution, Austria epidemiology, Case-Control Studies, Female, Humans, Logistic Models, Male, Odds Ratio, Risk Factors, Serbia ethnology, Young Adult, Yugoslavia ethnology, Emigrants and Immigrants, Myocardial Infarction ethnology
Abstract

We performed a hospital based case-control study to assess if the risk of myocardial infarction at a very young age (< or =40 years) was elevated in immigrants from the region of former Yugoslavia. Patients were classified as "exposed" if they or both their parents were born in former Yugoslavia. Consecutive myocardial infarction patients were recruited in the immediate post-infarction period from two Viennese hospitals over a 3.5-year period. Control patients free of myocardial infarction were frequency matched on age, gender, centre, and time in an approximate 1:2 ratio. Logistic regression was used for the assessment of an association between Yugoslavian descent and myocardial infarction. Overall, we recruited 102 myocardial infarction patients and 200 controls. The median age of infarction patients was 37.3 years. Yugoslavian descent was strongly associated with myocardial infarction (crude OR 7.3, 95% CI 3-18). This association was attenuated after multivariate adjustment (OR 3.9, 95% CI 1.2-13) but remained statistically significant. Using Miettinen's formula for population attributable risk, we calculated that between 15.3% (adjusted) and 17.8% (unadjusted) of myocardial infarction cases in very young patients could be attributable to immigrants from the studied region. In conclusion, we found that the risk of developing myocardial infarction at a young age is elevated in immigrants from the region of former Yugoslavia and their offspring. Even though residual confounding cannot be ruled out definitively, this risk seems to be independent of established cardiovascular risk factors.

Published
2009
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44. Statin use is associated with prolonged survival of renal transplant recipients.

Author

Wiesbauer F, Heinze G, Mitterbauer C, Harnoncourt F, Hörl WH, and Oberbauer R

Subjects
Adult, Cardiovascular Diseases etiology, Cardiovascular Diseases mortality, Cardiovascular Diseases prevention & control, Cohort Studies, Female, Graft Survival drug effects, Humans, Kaplan-Meier Estimate, Kidney Failure, Chronic complications, Kidney Failure, Chronic mortality, Kidney Failure, Chronic therapy, Male, Middle Aged, Proportional Hazards Models, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Kidney Transplantation mortality
Abstract

The efficacy of statins for the prevention of cardiovascular events is well established in the general population but remains unknown in renal transplant recipients. In this study, the association of statin use with patient and graft survival was investigated in a cohort of 2041 first-time recipients of renal allografts between 1990 and 2003. Multivariable Cox regression demonstrated that statin use was independently associated with lower mortality rates. Twelve-year survival rates were 73% for statin users and 64% for nonusers (P = 0.055). The adjusted hazard ratio for all-cause mortality associated with statin use was 0.64 (95% confidence interval 0.48 to 0.86). Graft survival rates during the same time period were 76% for statin users and 70% for nonusers (P = 0.055). The adjusted hazard ratio for graft survival associated with statin use was 0.76 (95% confidence interval 0.55 to 1.04). Results from marginal structural models were virtually identical. In summary, statin use was associated with prolonged patient survival, but no difference in graft survival was detected. Although these results are encouraging, a definitive causal relationship can be determined only from randomized clinical trials.

Published
2008
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45. Perioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and meta-analysis.

Author

Wiesbauer F, Schlager O, Domanovits H, Wildner B, Maurer G, Muellner M, Blessberger H, and Schillinger M

Subjects
Evidence-Based Medicine, Humans, Intraoperative Complications epidemiology, Intraoperative Complications mortality, Adrenergic beta-Antagonists therapeutic use, Intraoperative Complications prevention & control, Perioperative Care methods
Abstract

Background: Perioperative beta-blockers are suggested to reduce cardiovascular mortality, myocardial-ischemia/infarction, and supraventricular arrhythmias after surgery. We reviewed the evidence regarding the effectiveness of perioperative beta-blockers for improving patient outcomes after cardiac and noncardiac surgery., Methods: Eleven large databases were searched from the time of their inception until October 2005. Various online-resources were consulted for the identification of unpublished trials and conference abstracts. We included randomized, controlled trials comparing perioperative beta-blockers with either placebo or the standard-of-care. Of the 3680 retrieved titles, 69 met inclusion criteria for analysis. Odds ratios (OR) assuming random effects were computed in the absence of significant clinical heterogeneity., Results: Beta-blockers reduced the frequency of ventricular tachyarrhythmias [OR (cardiac surgery): 0.28, 95% CI 0.13-0.57; OR (noncardiac surgery): 0.56, 95% CI 0.21-1.45], atrial fibrillation/flutter [OR (cardiac surgery): 0.37, 95% CI 0.28-0.48], other supraventricular arrhythmias [OR (cardiac surgery): 0.25, 95% CI 0.18-0.35; OR (noncardiac surgery): 0.43, 95% CI 0.14-1.37], and myocardial ischemia [OR (cardiac surgery): 0.49, 95% CI 0.17-1.4; OR (noncardiac surgery): 0.38, 95% CI 0.21-0.69]. Length of hospitalization was not reduced [weighted mean difference (cardiac surgery): -0.35 days, 95% CI -0.77-0.07; weighted mean difference (noncardiac surgery): -5.59 days, 95% CI -12.22-1.04] and, in contrast to previous reports, beta-blockers did not reduce mortality [OR (cardiac surgery): 0.55, 95% CI 0.17-1.83; OR (noncardiac surgery): 0.78, 95% CI 0.33-1.87], and they had no influence on the occurrence of perioperative myocardial infarction [OR (cardiac surgery): 0.89, 95% CI 0.53-1.5; OR (noncardiac surgery): 0.59; 0.25-1.39]., Conclusions: Beta-blockers reduced perioperative arrhythmias and myocardial ischemia, but they had no effect on myocardial infarction, mortality, or length of hospitalization.

Published
2007
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46. Elevated plasma osteoprotegerin levels are associated with venous thrombosis and bleeding in patients with polycythemia vera.

Author

Kees M, Wiesbauer F, Gisslinger B, Wagner R, Shehata M, and Gisslinger H

Subjects
Adult, Aged, Aged, 80 and over, Analysis of Variance, Female, Hemorrhage blood, Humans, Male, Middle Aged, Osteoprotegerin, Polycythemia Vera blood, Prospective Studies, Retrospective Studies, Risk Factors, Venous Thrombosis blood, Glycoproteins blood, Hemorrhage etiology, Polycythemia Vera complications, Receptors, Cytoplasmic and Nuclear blood, Receptors, Tumor Necrosis Factor blood, Venous Thrombosis etiology
Abstract

Patients with polycythemia vera (PV) have an increased risk for the development of thrombohemorrhagic complications. The pathogenesis of these complications is still unclear. An important role in vascular disease has recently been attributed to osteoprotegerin (OPG). It has been shown that various tissues of the cardiovascular system produce OPG, and there is growing evidence of an association between elevated serum OPG levels and cardiovascular morbidity. We evaluated if OPG was associated with an increased risk of venous thrombosis or bleeding complications in a cohort of 114 PV patients. The analysis consisted of a retrospective and a prospective part. In the retrospective univariate analysis, a one unit change in OPG caused the odds of venous thrombosis to increase by 40% (p=0.005) and the odds of bleeding to increase by 52% (p=0.001). Multivariate analysis only slightly attenuated the association to 33% (p=0.03) and 37% (p=0.013) for venous thrombosis and bleeding, respectively. OPG was also related to the development of the combined outcome of venous thrombosis and bleeding in the prospective analysis (log-rank-test: p=0.017). This is the first report that links the occurrence of venous thrombosis or bleeding to elevated OPG levels.

Published
2005
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48. HMG CoA reductase inhibitors affect the fibrinolytic system of human vascular cells in vitro: a comparative study using different statins.

Author

Wiesbauer F, Kaun C, Zorn G, Maurer G, Huber K, and Wojta J

Subjects
Cell Line, Cell Survival drug effects, Cells, Cultured, Cholesterol metabolism, Coronary Vessels drug effects, Coronary Vessels physiology, Cytokines metabolism, Dose-Response Relationship, Drug, Endothelium, Vascular cytology, Endothelium, Vascular physiology, Gene Expression Regulation drug effects, Hepatocytes drug effects, Hepatocytes physiology, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Muscle, Smooth, Vascular cytology, Muscle, Smooth, Vascular physiology, Plasminogen Activator Inhibitor 1 genetics, Plasminogen Activator Inhibitor 1 metabolism, Tissue Plasminogen Activator genetics, Tissue Plasminogen Activator metabolism, Tumor Cells, Cultured, Umbilical Veins drug effects, Umbilical Veins physiology, Endothelium, Vascular drug effects, Fibrinolysis drug effects, Hydroxymethylglutaryl-CoA Reductase Inhibitors pharmacology, Muscle, Smooth, Vascular drug effects
Abstract

1. The results of several clinical studies investigating the effect of statin therapy on the fibrinolytic system in vivo are inconclusive. We compared the effect of six different statins (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, simvastatin) on components of the fibrinolytic system expressed by human vascular endothelial cells and smooth muscle cells and by the human hepatoma cell line HepG2. 2. All statins used except pravastatin significantly decreased PAI-1 production in human endothelial and smooth muscle cells. This effect was also seen in the presence of IL-1 alpha and TNF-alpha. All statins except pravastatin increased t-PA production in human smooth muscle cells. On a molar basis cerivastatin was the most effective HMG CoA reductase inhibitor used. Only simvastatin and lovastatin increased t-PA production in endothelial cells. The effects on the fibrinolytic system were reversed by mevalonate. Statins decreased mRNA levels for PAI-1 in endothelial and smooth muscle cells and increased mRNA levels for t-PA in smooth muscle cells. Statins did not affect PAI-1 expression in HepG2 cells. Cell viability was not influenced by statins in endothelial cells and HepG2 cells whereas in smooth muscle cells a cytotoxic effect was seen at high concentrations. 3. If the effects on the fibrinolytic system of vascular cells in vitro shown in this study are also operative in vivo one could speculate that by increasing t-PA and decreasing PAI-1 at sites of vascular lesions statins might reduce fibrin formation and thrombus development. Such an effect might contribute to the clinically proven benefits of statin therapy.

Published
2002
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