Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. Study on clinical characteristics and prognosis of a large ...contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62-77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008-2013 and 29.9% in 2014-2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08-1.23), intracardiac abscess (OR:1.78, 95% CI:1.30-2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31-4.19), acute renal failure (OR: 3.11, 95% CI:1.14-2.09), septic shock (OR: 5.56, 95% CI:3.55-8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21-2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49-2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND—Atrial fibrillation is characterized by progressive atrial structural and electrical changes (atrial remodeling) that favor arrhythmia recurrence and maintenance. Reduction of L-type Ca ...current (ICa,L) density is a hallmark of the electrical remodeling. Alterations in atrial microRNAs could contribute to the protein changes underlying atrial fibrillation–induced atrial electrical remodeling. This study was undertaken to compare miR-21 levels in isolated myocytes from atrial appendages obtained from patients in sinus rhythm and with chronic atrial fibrillation (CAF) and to determine whether L-type Ca channel subunits are targets for miR-21.
METHODS AND RESULTS—Quantitative polymerase chain reaction analysis showed that miR-21 was expressed in human atrial myocytes from patients in sinus rhythm and that its expression was significantly greater in CAF myocytes. There was an inverse correlation between miR-21 and the mRNA of the α1c subunit of the calcium channel (CACNA1C) expression and ICa,L density. Computational analyses predicted that CACNA1C and the mRNA of the β2 subunit of the calcium channel (CACNB2) could be potential targets for miR-21. Luciferase reporter assays demonstrated that miR-21 produced a concentration-dependent decrease in the luciferase activity in Chinese Hamster Ovary cells transfected with CACNA1C and CACNB2 3′ untranslated region regions. miR-21 transfection in HL-1 cells produced changes in ICa,L properties qualitatively similar to those produced by CAF (ie, a marked reduction of ICa,L density and shift of the inactivation curves to more depolarized potentials).
CONCLUSIONS—Our results demonstrated that CAF increases miR-21 expression in enzymatically isolated human atrial myocytes. Moreover, it decreases ICa,L density by downregulating Ca channel subunits expression. These results suggested that this microRNA could participate in the CAF-induced ICa,L downregulation and in the action potential duration shortening that maintains the arrhythmia.
Este artículo presenta una revisión acerca de la revascularización con doble injerto de arteria mamaria interna.
A modo de introducción se presenta la evidencia existente en favor del uso de injertos ...arteriales frente al empleo de la vena safena interna como injerto en la cirugía de revascularización coronaria y, seguidamente, se revisan cada uno de los tipos de injerto arterial empleados, con sus ventajas e incovenientes.
Tras ello, se realiza una revisión pormenorizada de cada uno de los aspectos relevantes en el uso del doble injerto de arteria mamaria, empezando por su anatomía e histología. A continuación, se revisan los aspectos técnicos más importantes y los resultados publicados tanto a corto como a medio-largo plazo. Por último, se hace referencia a las complicaciones asociadas a su uso.
This article presents a review of coronary artery bypass grafting surgery using double internal mammary artery grafts.
As an introduction, evidence in favour of arterial revascularization against saphenous vein grafts is presented and then, a review of the different options used as arterial grafts is commented, with its advantages and disadvantages.
After that, a detailed review of each of the relevant aspects in the use of double mammary artery grafting is carried out, starting with its anatomy and histology. Next, the most important technical aspects and results published both int the short and mid-long term are reviewed. Finally, a reference is made to the complications associated with its use.
Abstract
Aims
Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in ...these patients.
Methods and results
Infective endocarditis cases were prospectively identified in the Spanish National Endocarditis Registry. From 3996 IE, 708 (17.7%) had a CIED and 424 CIED-related IE (lead vegetation). Patients with a CIED were older (68 ± 11 vs. 73 ± 8 years); had more comorbidities {pulmonary disease 176 (24.8%) vs. 545 (16.7%), renal disease 239 (33.8%) vs. 740 (22.7%), diabetes 248 (35.0%) vs. 867 (26.6%), and heart failure 348 (49.2%) vs. 978 (29.9%)}; and fewer complications {intracardiac destruction 106 (15%) vs. 1077 (33.1%), heart failure 215 (30.3%) vs. 1340 (41.1%), embolism 107 (15.1%) vs. 714 (21.9%), and neurological involvement 77 (10.8%) vs. 702 (21.5%)} (all P-values <0.001) in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without CIED 171 (24.2%) vs. 881 (27.0%), P = 0.82. In subjects with a CIED, CIED-related IE was independently associated with in-hospital survival: odds ratio (OR) 0.4 95% confidence interval (CI) 0.3–0.7, P = 0.001. Surgery was independently associated with in-hospital survival in CIED-related IE: OR 0.4 (95% CI 0.2–0.7, P = 0.004); but not in subjects with valve IE and no CIED lead involvement: OR 0.9 (95% CI 0.5–1.7, P = 0.77).
Conclusion
Over a sixth of IE patients have a CIED. This group of patients is older, with more comorbidities and fewer IE-related complications in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without a CIED.
Left ventricular hypertrophy (LVH) has been associated with oxidative stress, although not with the protein thiolation index (PTI). This study explored the potential use of PTI as a biomarker of ...oxidative stress in patients with LVH.
We recruited 70 consecutive patients (n = 35 LVH and n = 35 non-LVH) based on an echocardiography study in our institution (left ventricular mass indexed to body surface area). Plasma levels of both S-thiolated protein and total thiols were measured as biomarkers of oxidative stress by spectrophotometry, and PTI was calculated as the molar ratio between S-thiolated proteins and the total thiol concentration.
Values for plasma S-thiolated proteins were higher in patients with LVH than in the control group (P = 0.01). There were no differences in total thiols between the LVH group and the control group. Finally, PTI was higher in patients with LVH than in the control group (P = 0.001). The area under the ROC curve was 0.75 (95% CI, 0.63-0.86; P<0.001), sensitivity was 70.6%, and specificity was 68.6%, thus suggesting that PTI could be used to screen for LVH. A multivariable logistic regression model showed a positive association (P = 0.02) between PTI and LVH (OR = 1.24 95% CI, 1.03-1.49) independently of gender (OR = 3.39 95% CI, 0.60-18.91), age (OR = 1.03 95% CI, 0.96-1.10), smoking (OR = 5.15 95% CI, 0.51-51.44), glucose (OR = 0.99 95% CI, 0.97-1.01), systolic arterial pressure (OR = 1.10 CI 1.03-1.17), diastolic arterial pressure (OR = 0.94 CI 0.87-1.02), dyslipidemia (OR = 1.46 95% CI, 0.25-8.55), estimated glomerular filtration rate (OR = 0.98 95% CI, 0.96-1.01), body mass index (OR = 1.03 95% CI, 0.90-1.10), and valvular and/or coronary disease (OR = 5.27 95% CI, 1.02-27.21).
The present study suggests that PTI could be a new biomarker of oxidative stress in patients with LVH.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
osteomyelitis is a rare complication of extrapulmonary invasive aspergillosis, which usually presents as spondylodiscitis. The clinical picture is usually paucisymptomatic and of long evolution, ...which leads to diagnostic difficulties, especially in immunosuppressed patients presenting a delayed systemic host response. We report a case of femoral osteomyelitis caused by
in a heart transplant recipient successfully treated with a combined surgical and antifungal approach. A 65-year-old heart transplant male presented with left knee pain lasting 3 months. X-ray and magnetic resonance imaging identified a lesion with aggressive characteristics at the distal third of the left femur, due to which the patient underwent excisional surgery.
was cultured from the removed material and antifungal treatment with oral isavuconazole was started. Chest imaging excluded pulmonary aspergillosis, while the positron emission tomography/computed tomography (PET/CT) identified a remnant of a prosthetic vascular graft sewn to the proximal third of the right axillary artery, through which a catheter-based micro-axial left ventricular assist device was implanted previously as bridge to transplant therapy. The patient presented a rapid clinical improvement with complete functional recovery following the surgical treatment and the antifungal therapy and finally underwent surgical removal of the residual vascular graft. This is the first reported episode of long bone osteomyelitis due to
that occurred in a heart transplant recipient without pulmonary infection and was successfully treated with isavuconazole. The PET/CT was useful in supporting the diagnostic process and follow-up. Cryptic fungal species can cause invasive infections, particularly in immunocompromised patients. Molecular methods are crucial in fungal identification.
En la enfermedad reumática con afectación mitral, la insuficiencia es la forma de presentación más frecuente en gente joven. La posibilidad de reparación quirúrgica en la insuficiencia reumática ...depende fundamentalmente de factores anatómicos de la válvula, como son la flexibilidad del velo anterior y la presencia de lesiones calcificadas a nivel del aparato subvalvular, pero también de la experiencia del centro en reparación mitral compleja. Todo ello hace que esta patología infradiagnosticada haya quedado relegada a la sustitución protésica, ya que en muchos casos es remitida de forma tardía con una calcificación avanzada. Con el fin de desmitificar esta entidad, en el siguiente artículo abordaremos la insuficiencia mitral reumática y su tratamiento con las técnicas específicas reparadoras, así como la presentación de nuestra experiencia y una discusión de la patología con revisión de la literatura publicada hasta la fecha.
In rheumatic disease with mitral involvement, regurgitation is the most common form of presentation in young people. The possibility of surgical repair in rheumatic regurgitation depends on anatomical factors of the valve, such as the flexibility of the anterior leaflet and the presence of calcified lesions at the level of the subvalvular apparatus, but also on the experience of the center in complex mitral repair. All this means that this underdiagnosed pathology has been relegated to prosthetic replacement, since in many cases it is remitted late with advanced calcification. In order to demystify this entity, in the following article we will address rheumatic mitral regurgitation and its treatment with specific repair techniques, as well as the presentation of our experience and a discussion of the pathology with a review of the literature.
Background:
A recently developed global indicator of oxidative stress (OXY-SCORE), by combining individual plasma biomarkers of oxidative damage and antioxidant capacity, has been validated in ...several pathologies, but not in left ventricular hypertrophy (LVH). The aim of this study was to design and calculate a plasma oxidative stress global index for patients with LVH.
Methods:
A total of 70 consecutive adult patients were recruited in our institution and assigned to one of the two study groups (control group/LVH group) by an echocardiography study. We evaluated plasmatic biomarkers of oxidative damage (malondialdehyde and thiolated proteins) and antioxidant defense (total thiols, reduced glutathione, total antioxidant capacity, catalase, and superoxide dismutase activities) by spectrophotometry/fluorimetry in order to calculate a plasma oxidative stress global index (OXY-SCORE) in relation to LVH.
Results:
The OXY-SCORE exhibited a highly significant difference between the groups (p < 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval (CI), 0.62–0.85; p < 0.001). At a cut-off value of −1, the 68.6% sensitivity and 68.6% specificity values suggest that OXY-SCORE could be used to screen for LVH. A multivariable logistic regression model showed a positive association (p = 0.001) between OXY-SCORE and LVH odds ratio = 0.55 (95% CI, 0.39–0.79), independent of gender, age, smoking, glucose, systolic and diastolic arterial pressure, dyslipidemia, estimated glomerular filtration rate, body mass index, and valvular/coronary disease.
Conclusion:
OXY-SCORE could help in the diagnosis of LVH and could be used to monitor treatment response.
BACKGROUNDAbiotrophia spp. and Granulicatella spp. are Gram-positive cocci, formerly known as nutritionally variant or deficient Streptococcus. Their role as causative agents of infective ...endocarditis (IE) is numerically uncertain, as well as diagnostic and clinical management of this infection. The aim of our study is to describe the clinical, microbiological, therapeutic, and prognosis of patients with IE caused by these microorganisms in a large microbiology department. METHODSRetrospective analysis of all the patients with Abiotrophia spp. and Granulicatella spp. IE registered in our centre in the period 2004-2021. RESULTSOf the 822 IE in the study period, 10 (1.2%) were caused by Abiotrophia spp. (7) or Granulicatella spp. (3). The species involved were A.defectiva (7), G.adiacens (2) and G.elegans (1). Eight patients were male, their mean age was 46 years and four were younger than 21 years. The most frequent comorbidities were congenital heart disease (4; 40%) and the presence of intracardiac prosthetic material (5; 50%). IE occurred on 5 native valves and 5 prosthetic valve or material. Blood cultures were positive in 8/10 patients, within a mean incubation period of 18.07 hours. In the other two patients, a positive 16SPCR from valve or prosthetic material provided the diagnosis. Surgery for IE was performed in seven patients (70%) and in all cases positive 16S rRNA PCR and sequencing from valve or prosthetic material was demonstrated. Valves and/or prosthetic removed material cultures were positive in four patients. Nine patients received ceftriaxone (4 in monotherapy and 5 in combination with other antibiotics). The mean length of treatment was 6 weeks and IE-associated mortality was 20% at one year follow-up. CONCLUSIONSAbiotrophia spp. or Granulicatella spp. IE were infrequent but not exceptional in our environment and particularly affected patients with congenital heart disease or prosthetic material. Blood cultures and molecular methods allowed the diagnosis. Most of them required surgery and the associated mortality, in spite of a mean age of 46 years, was high.
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