Abstract 13434: Improved Diagnostic Performance of Contemporary Transesophageal Echocardiography With Three-dimensional Imaging for Infective Endocarditis

Introduction: Infective endocarditis (IE) is associated with high morbidity and mortality. Conventionally, a repeat transesophageal echocardiogram (TEE) is necessary if the first TEE is negative, and there is high clinical suspicion. We aimed to investigate the diagnostic performance of contemporary TEE for IE. Hypothesis: We hypothesize that with advancements in TEE imaging, including three-dimensional (3D) imaging, the diagnostic performance of TEE for IE would be improved. Methods: Patients who had two or more TEEs at our center, within 6 months, for evaluation of IE in 2011 (pre-3D imaging) and 2019 (post-3D imaging) were included. Patients not meeting the Duke criteria for IE (n=899) were excluded. The primary endpoint was the sensitivity of TEE to detect IE. TEE sensitivity was also compared among the different subtypes of IE (native valve, prosthetic valve, device-related, central line-related, and aortic prosthetic graft-related). Results: 242 patients were included: 70 in 2011 and 172 in 2019. In 2011, there were more smokers and a lower rate of pacing devices; otherwise, there were no significant differences in baseline characteristics, including intravenous drug use. The sensitivity of the initial TEE for IE was 85.7% in 2011, improving significantly to 95.3% in 2019 (p=0.01). The improved diagnostic performance in 2019 was mainly driven by the improved detection of prosthetic valve IE (70.8% vs. 93.7%, p=0.009). There were no significant differences for the other subtypes of IE (Figure). In 2019, patients had a higher rate of IE diagnosis within 15 days of index admission, which did not reach statistical significance (n=161, 93.6% vs. n=62, 88.6% in 2011, p=0.19). Kaplan Meier analysis demonstrated that patients in 2019 had a higher rate of procedures for endocarditis (p=0.01). Conclusions: Contemporary TEE imaging including 3D technology improved the detection of IE on the initial TEE, mainly driven by improved detection of prosthetic valve IE.

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Prosthetic valve endocarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0392 ◽

2018 ◽

pp. 1720-1723

Author(s):

José A. San Román ◽

Javier López

Keyword(s):

Computed Tomography ◽

Infective Endocarditis ◽

Antibiotic Treatment ◽

Prosthetic Valve ◽

Photon Emission ◽

Clinical Manifestations ◽

Prosthetic Valve Endocarditis ◽

Native Valve ◽

Native Valve Endocarditis ◽

Duke Criteria

Prosthetic valve endocarditis (PVE) complicates the clinical course of 1–6% of patients with prosthetic valves and it is one of the types of infective endocarditis with the worst prognosis. In early-onset PVE (that occurs within the first year after surgery), the microbiological profile is dominated by staphylococci. In late-onset PVE, the microorganisms are similar to native valve endocarditis. Clinical manifestations are very variable and depend on the causative microorganism. The diagnosis is established with the modified Duke criteria although they yield lower diagnostic accuracy than in native valve endocarditis. Transoesophageal echocardiography is the main imaging technique in everyday clinical practice in PVE as the sensitivity is higher than transthoracic echocardiography. The findings of other techniques, as cardiac computed tomography (CT), positron emission tomography/CT, or single-photon emission computed tomography/CT have been recently recognized as new major diagnostic criteria and can be very useful in cases with a high level of clinical suspicion and negative echocardiography. Empirical antibiotic treatment should cover the most frequent microorganisms, especially staphylococci. Once the microbiological diagnosis is made, the antibiotic treatment is similar to native valve infective endocarditis, except for the addition of rifampicin in staphylococcal PVE and a longer length (up to 6 weeks) of the treatment. Surgical indications are also similar to native valve endocarditis, heart failure being the most common and embolic prevention the most debatable. Prognosis is bad, and during the follow-up, a team experienced with endocarditis is needed. Patients with a history of PVE should receive antibiotic prophylaxis if they undergo invasive dental manipulations.

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P202 Two-dimensional and three-dimensional transesophageal echocardiography in the diagnosis of infective endocarditis of native and prosthetic valves

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.070 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

L Capotosto ◽

G Tanzilli ◽

E Mangieri ◽

M R Ciardi ◽

C Gaudio ◽

...

Keyword(s):

Infective Endocarditis ◽

Transesophageal Echocardiography ◽

Prosthetic Valve ◽

Three Dimensional ◽

Valve Prosthesis ◽

Two Dimensional ◽

Chordae Tendineae ◽

Native Valve ◽

Prosthetic Valves ◽

Sensitivity Specificity

Abstract Purpose The purpose of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3D-TEE) compared to two-dimensional transesophageal echocardiography (2D-TEE) in the diagnosis of infective endocarditis (IE) of native and prosthetic valves. Methods Forty-three patients with clinically suspected IE were studied. The patients had clinical, microbiological and echocardiographic assessment to establish a diagnosis of IE in accordance to current guidelines recommendations. Presence, location and size of vegetations, new or progressive valve regurgitation, possible chordae tendineae rupture, paravalvular extension, and new dehiscence of a valve prosthesis were assessed by echocardiography. Results In 25 (58%) patients the diagnosis of IE was established. Thirteen patients had native valves and 12 patients had prosthetic valves (9 mechanical, 3 biological). 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 91% and 89%, 88% and 91%, 84% and 86%, and 93% and 90%, respectively, in native valves, and of 92 and 90% 91% and 97% (p = 0.002), 84% and 82% and 89% and 95% (p = 0.01), respectively, in patients with prosthetic valves. Major vegetation diameter was 18mm for 3D-TEE and 16mm for 2D-TEE in native valves and 19mm for 3D-TEE and 14mm for 2D-TEE in prosthetic valves (p = 0.04). Peri-annular extension was detected by any of the echocardiographic modalities in three patients with native valve IE and two patients with prosthetic valves, and by 3D-TEE only and not by 2D-TEE in one patient with prosthetic valve. Conclusions Patients with prosthetic valve infective endocarditis seem to have more additive benefit from 3D-TEE compared to patients with native valve IE.

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The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

Current Pharmaceutical Biotechnology ◽

10.2174/1389201021666200423110359 ◽

2020 ◽

Vol 21 (12) ◽

pp. 1140-1153 ◽

Cited By ~ 1

Author(s):

Mohammad A. Noshak ◽

Mohammad A. Rezaee ◽

Alka Hasani ◽

Mehdi Mirzaii

Keyword(s):

Foreign Body ◽

Infective Endocarditis ◽

Prosthetic Valve ◽

Human Life ◽

Prosthetic Valve Endocarditis ◽

Surgical Site Infections ◽

Coagulase Negative Staphylococci ◽

Native Valve ◽

Native Valve Endocarditis

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

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Corynebacterium jeikeium native valve infective endocarditis case report: a confirmed microbiological and pathological diagnosis from heart valvular tissue

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa365 ◽

2020 ◽

Author(s):

Wentzel Bruce Dowling ◽

Johan Koen

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Penicillin G ◽

Peripheral Vascular ◽

Native Valve ◽

Valve Tissue ◽

Case Summary ◽

Duke Criteria ◽

G Prior ◽

Initial Blood

Abstract Background The Modified Duke criteria is an important structured schematic for the diagnosis of infective endocarditis (IE). Corynebacterium jeikeium is a rare cause of IE that is often resistant to standard IE anti-microbials. We present a case of C. jeikeium IE, fulfilling the Modified Duke pathological criteria. Case summary A 50-year-old male presented with left leg peripheral vascular disease with septic changes requiring amputation. Routine echocardiography post-amputation demonstrated severe aortic valve regurgitation with vegetations that required valve replacement. Two initial blood cultures from a single venepuncture showed Streptococcus mitis which was treated with penicillin G prior to surgery. Subsequent aortic valve tissue cultured C. jeikeium with suggestive IE histological valvular changes and was successfully treated on a prolonged course of vancomycin. Discussion This is the first C. jeikeium IE case diagnosed on heart valvular tissue culture and highlights the importance for the fulfilment of the Modified Duke criteria in diagnosing left-sided IE. Mixed infection IE is rare, and this case possibly represents an unmasking of resistant C. jeikeium IE following initial treatment of penicillin G.

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Abstract WP335: Intracranial Mycotic Aneurysms in Infective Endocarditis: Incidence, Predictors and Outcome

Stroke ◽

10.1161/str.48.suppl_1.wp335 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mehmet A Topcuoglu ◽

Oguzhan Kursun ◽

Ferdinando S Buonanno ◽

Aneesh B Singhal

Keyword(s):

Infective Endocarditis ◽

Mitral Regurgitation ◽

Multivariable Analysis ◽

Native Valve ◽

Duke Criteria ◽

Mycotic Aneurysms ◽

Mean Size ◽

Pre Treatment ◽

Cardiac Valve Disease

Introduction: Intracranial mycotic aneurysms (IMA) are rare but serious complications of infective endocarditis (IE). Methods and Results: In this retrospective study (1980-2011) we used original Duke criteria to diagnose IE in 1149 episodes (1081 patients; 81% definite, 80% native valve). Neuro complications occurred in 28%, stroke in 22% (202 infarcts, 53 hemorrhages) and 1% had TIA/TMB. N=33 IMA were detected in 23 (2%) patients. IMA were detected in 8% with focal neuro deficits, 13% with seizures, and 3% with encephalopathy. IMA-related symptoms were present in 22 of 23 cases: headache 48%, seizure 13%, altered sensorium 35% and focal deficits 61%. IMA were detected in 0/885 without stroke, 5.4% with infarcts and 22.6% with hemorrhages (p<0.001); the latter included 9/36 (25%) with ICH, 3/13 (23%) with SAH, and 0/4 with SDH. Of the 23 IMA patients 61% had hemorrhage, 30% had SAH and 57% had infarcts. IMAs were detected by DSA in 21/166 (12.7%). The mean size was 3.6±2.4 mm; 30% multiple; 61% located in distal segments; and 67% in MCA branches. On MRI, 31 had any SAH and 45 had any ICH; IMA detected in 6/9 with diffuse SAH, 2/22 with convexal SAH, 11/45 with ICH, and 11/202 with infarcts. Patients with IMA had higher rates of women, hypertension, known cardiac valve disease, mitral regurgitation, mitral vegetation and S.viridians infection (all p<0.05). On multivariable analysis, mitral regurgitation with vegetation (OR 5.9, 95% CI 2.5-14.0, p<0.001) was the only independent predictor of IMA. Clipping was performed in 8 (all pre-2000); endovascular treatment in 7 (all post-1997); 2 died pre- treatment; 1 detected on autopsy; 1 no follow-up available, and 4 regressed/disappeared with antibiotics. Patients with and without IMA showed no difference in rates of in-hospital mortality (22% v. 19%, p=0.93), and length of stay (32d v. 24d, p=0.28). IMA rates did not decrease during the study period (2.2% in 784 episodes 1980-2000 vs. 1.6% of 365 episodes 2001-2011, p=0.653). Conclusion: IMA are invariably heralded by neurological symptoms and stroke (especially hemorrhages) on brain imaging. Mitral IE has the highest risk for IMA. IMAs can resolve with antibiotics however studies are needed to determine the efficacy of different treatment approaches.

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Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review

Medicina ◽

10.3390/medicina58010023 ◽

2021 ◽

Vol 58 (1) ◽

pp. 23

Author(s):

Vedran Carević ◽

Zorica Mladenović ◽

Ružica Perković-Avelini ◽

Tina Bečić ◽

Mislav Radić ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Prosthetic Valve ◽

Three Dimensional ◽

Prosthetic Valve Endocarditis ◽

Valve Surgery ◽

Optimal Time ◽

Imaging Method ◽

Fatal Complication ◽

Native Valve ◽

Surgical Interventions

Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application.

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Clinical and pathogen features of infective endocarditis:A retrospective study of 111 episodes in a teaching hospital in southwest China

10.21203/rs.2.9194/v1 ◽

2019 ◽

Author(s):

Yuanfang Wang ◽

Mei Kang ◽

Ya Liu ◽

Siyin Wu ◽

Weili Zhang ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Heart Disease ◽

Infective Endocarditis ◽

Laboratory Data ◽

Clinical Manifestations ◽

Resistance Rate ◽

Native Valve ◽

Duke Criteria ◽

Preventive Medication ◽

History Of

Abstract Background Infective endocarditis (IE) is a health-threaten infectious disease. Diverse and complicated etiology and causative microorganisms make IE difficult to diagnose and treat. As we know, current investigations of clinical and pathogen features of IE in West china are scarce. In this study, we aimed to investigate the epidemiology and pathogen characteristic of IE in our region. Methods A retrospective analysis of clinical and laboratory data was performed from all blood culture positive IE patients between 2012 to 2017 in Westchina Hospital of Sichuan University。The diagnosis is traditionally based on the modified Duke criteria. Results The mean age of the patient cohort was 40.7±21.5 years (ranging from 2-78); 73 cases (65.2%) were males and 39 cases (34.8%) were females. Of the 111 cases, 100 were native valve endocarditis (NVE) while 11 were prosthetic valve endocarditis (PVE), 87 cases (78.4%) were left-heart infection. Congenital heart disease (28.6%) and rheumatic heart disease (11.6%) were most common history of heart disease. Primary clinical manifestations were fever (87.5%) and heart murmur (78.6%).Streptococci spp (20.7%) was the most common organism, followed by Staphylococcus spp(17.9%). Streptococcus viridians showed no resistance to penicillin, erythromycin and clindamycin resistance rate were 47.4% and 40%. Benzocillin resistance rate of staphylococcus aureus to was 26.3%. Vancomycin or linezolid resistance staphylococcus aureus were not found. 75 patients died while 36 patients survived at last. With respect to risk factors, history of heart disease was the only prognostic risk factor (OR: 0.239, 95%CI 0.08-0.68) Conclusions Epidemiological and clinical characteristics of infective endocarditis are various and complex, distribution of pathogen is regional difference. Our research of infective endocarditis with bloodstream infection verified regional characteristics of infective endocarditis. The variations we observed in the study will be of important value to clinical preventive medication in our region.

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Comparison Between ESC and Duke Criteria for the Diagnosis of Prosthetic Valve Infective Endocarditis

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2020.04.011 ◽

2020 ◽

Vol 13 (12) ◽

pp. 2605-2615 ◽

Cited By ~ 1

Author(s):

Mary Philip ◽

Laetitia Tessonier ◽

Julien Mancini ◽

Jean-Luc Mainardi ◽

Marie-Paule Fernandez-Gerlinger ◽

...

Keyword(s):

Infective Endocarditis ◽

Prosthetic Valve ◽

Duke Criteria

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Addition of Rifampin to Standard Therapy for Treatment of Native Valve Infective Endocarditis Caused by Staphylococcus aureus

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00300-08 ◽

2008 ◽

Vol 52 (7) ◽

pp. 2463-2467 ◽

Cited By ~ 83

Author(s):

David J. Riedel ◽

Elizabeth Weekes ◽

Graeme N. Forrest

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Drug Interactions ◽

Standard Therapy ◽

Cohort Analysis ◽

Urban Hospital ◽

Hepatitis C Infection ◽

Native Valve ◽

Duke Criteria ◽

The Impact

ABSTRACT Staphylococcus aureus is a common cause of native valve infective endocarditis (IE). Rifampin is often added to traditional therapy for the management of serious S. aureus infections. There are no large, prospective studies documenting the safety and efficacy of adjunctive therapy with rifampin for treatment of native valve S. aureus IE. We reviewed all cases of definite native valve S. aureus IE confirmed by modified Duke criteria in a large urban hospital between 1 January 2004 and 31 December 2005. A retrospective cohort analysis was used to assess the impact of the addition of rifampin to standard therapy. There were 42 cases of S. aureus IE treated with the addition of rifampin and 42 controls. Cases received a median of 20 days of rifampin (range, 14 to 48 days). Rifampin-resistant S. aureus isolates developed in nine cases who received rifampin before clearance of bacteremia (56%), while significant hepatic transaminase elevations also occurred in nine cases, all of whom had hepatitis C infection. Unrecognized significant drug-drug interactions with rifampin occurred frequently (52%). Cases were more likely to have a longer duration of bacteremia (5.2 versus 2.1 days; P < 0.001) and were less likely to survive (79% versus 95%; P = 0.048) than controls. Our results suggest that the potential for hepatotoxicity, drug-drug interactions, and the emergence of resistant S. aureus isolates warrants a careful risk-benefit assessment before adding rifampin to standard antibiotic treatment of native valve S. aureus IE until further clinical studies are performed.

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Modified Commando Procedure in Complicated Infective Endocarditis - A Case Series.

10.21203/rs.3.rs-105185/v1 ◽

2020 ◽

Author(s):

Po Sung Chen ◽

Chungyi Chang ◽

Yicheng Chuang ◽

Ichen Chen ◽

Tingchao Lin

Keyword(s):

Infective Endocarditis ◽

Prosthetic Valve ◽

Case Series ◽

Prosthetic Valve Endocarditis ◽

Surgical Mortality ◽

Native Valve ◽

Case Presentation ◽

Native Valve Endocarditis ◽

Fibrous Body ◽

Urgent Surgery

Abstract Background: Complicated infective endocarditis (IE) with perivalvular abscess and destruction of intervalvular fibrous body (IFB) has high mortality risk and requires emergent or urgent surgery mostly. Case presentation: We presented four patients with complicated infective endocarditis combined with perivalvular abscess and IFB destruction. Three patients had prosthetic valve endocarditis and one patient had native valve endocarditis. They all received modified Commando procedure successfully. No surgical mortality or re-exploration for bleeding. Conclusions: We suggest that modified Commando procedure may have some benefit in improving survival rate of patients with complicated IE and reducing complications.

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