Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Mangner Norman, Panagides Vassili, Del Val David, Abdel-Wahab Mohamed, Crusius Lisa, Durand Eric, Ihlemann Nikolaj, Urena Marina, Pellegrini Costanza, Giannini Francesco, Gasior Tomasz, Wojakowski Wojtek, Landt Martin, Auffret Vincent, Sinning Jan-Malte, Cheema Asim N, Nombela-Franco Luis, Chamandi Chekrallah, Campelo-Parada Francisco, Munoz-Garcia Erika, Herrmann Howard C, Testa Luca, Kim Won-Keun, Eltchaninoff Helene, Søndergaard Lars, Himbert Dominique, Husser Oliver, Latib Azeem, Le Breton Hervé, Servoz Clement, Gervais Philippe, Côté Mélanie, Thiele Holger, Holzhey David, Linke Axel, Rodés-Cabau Josep
Аннотация
METHODS: Patients with definite TAVI-IE derived from the Infectious Endocarditis after TAVI International Registry were investigated comparing those with absent and evident echocardiographic signs of IE defined as vegetation, abscess, pseudo-aneurysm, intracardiac fistula, or valvular perforation or aneurysm.
RESULTS: Among 578 patients, 87 (15.1%) and 491 (84.9%) had absent (IE-neg) and evident (IE-pos) echocardiographic signs of IE, respectively. IE-neg were more often treated via a transfemoral access with a self-expanding device and had higher rates of peri-interventional complications (eg, stroke, major vascular complications) during the TAVI procedure (P < .05 for all). IE-neg had higher rates of IE caused by Staphylococcus aureus (33.7% vs 23.2%; P = .038) and enterococci (37.2% vs 23.8%; P = .009) but lower rates of coagulase-negative staphylococci (4.7% vs 20.0%, P = .001). IE-neg was associated with the same dismal prognosis for in-hospital mortality in a multivariate binary regression analysis (odds ratio: 1.51; 95% confidence interval [CI]: .55-4.12) as well as a for 1-year mortality in Cox regression analysis (hazard ratio: 1.10; 95% CI: .67-1.80).
CONCLUSIONS: Even with negative echocardiographic imaging, patients who have undergone TAVI and presenting with positive blood cultures and symptoms of infection are a high-risk patient group having a reasonable suspicion of IE and the need for an early treatment initiation.