Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome

AbstractObjectivesTo describe the epidemiological, clinical, and laboratory profile of infective endocarditis (IE) at a Brazilian tertiary care center, and to identify the predictors of in-hospital mortality.MethodsData from 62 patients who fulfilled the modified Duke's criteria for IE during a seven-year period were gathered prospectively. The Cox proportional hazards model was used to identify predictive factors for death.ResultsThe mean age of patients was 45 years, and 39 patients (63%) were male. The median time from admission to diagnosis was 15 days. Rheumatic heart disease was the predominant underlying heart condition (39%), followed by valvular prosthesis (31%). Neurological complications were observed in 12 patients (19%). Echocardiography demonstrated one or more vegetations in 84% of cases. The infective agent was identified in 65% of cases, and the most frequent causative agents were staphylococci (48%), followed by streptococci (20%). The median duration of hospitalization was 39 days. Surgery was performed during the acute phase of the IE in 53% of cases. The overall in-hospital mortality was 31%. On multivariate analysis, vegetation length >13mm remained the only independent predictor of in-hospital mortality (hazard ratio 1.05 per millimeter, 95% confidence interval 1.003–1.110, p=0.038).ConclusionsIE remains a severe disease affecting the young population in Brazil, and rheumatic heart disease continues to be the most common underlying heart condition. Large vegetation size, assessed early in the course of IE by transesophageal echocardiography, along with the clinical and microbiological features, may predict in-hospital death

II Diretriz Brasileira de Transplante Cardíaco

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasIIHospital de Messejana Dr. Carlos Alberto Studart GomesUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaInstituto Dante Pazzanese de CardiologiaUniversidade Federal de Minas Gerais Hospital das ClínicasFaculdade de Medicina de São José do Rio PretoPontifícia Universidade Católica do ParanáIHospital Israelita Albert EinsteinInstituto Nacional de Cardiologia, Fundação Universitária do Rio Grande do Sul Instituto de CardiologiaReal e Benemérita Sociedade de Beneficência Portuguesa, São PauloHospital Pró-Cardíaco do Rio de JaneiroSanta Casa do Rio de JaneiroUNIFESP, EPMSciEL

O valor pré-operatório dos níveis plasmáticos do receptor solúveldo fator de necrose tumoral tipo I (rs-FNT I) como preditor decomplicações após revascularização do miocárdio e operaçõesvalvares

Exportado OPUSMade available in DSpace on 2019-08-13T05:21:59Z (GMT). No. of bitstreams: 1 cl_udio_leo_gelape.pdf: 187821 bytes, checksum: 3744d036d79a3050dd792f1bfda63936 (MD5) Previous issue date: 30Objetivo: O objetivo desse estudo foi avaliar a dosagem pré-operatória do receptor solúvel do Fator de Necrose Tumoral tipo I (rs-FNT I) como preditor de evolução desfavorável e mortalidade no pós-operatório de revascularização miocárdica (RM) e operações valvares. Método: Avaliou-se prospectivamente, 62 pacientes (47 homens - 75,8%) submetidos a operações eletivas de RM com circulação extracorpórea (n=43) ou cirurgia valvar (n=19). O nível sérico do rs-FNT I (picogramas/mililitro) determinado no momento da indução anestésica, foi comparado com as características clínicas e cirúrgicas dos pacientes que apresentaram boa evolução (grupo I, n=46) ou evolução desfavorável (grupo II, n=16), definida como permanência no CTI maior que 72 horas ou óbito intra-hospitalar. Resultados: Não houve diferença entre a mortalidade verificada (6,4%) e a prevista pelo EuroSCORE(3,0%), p=0,48. Níveis séricos de rs-FNT I foram mais altos nos pacientes do grupo II (1.322 [694-1.635]) do que nos do grupo I (748 [532-1.041]); p=0,009. Níveis maiores que 954, apresentaram sensibilidade de 69% e especificidade de 70% para evolução desfavorável com valor preditivo positivo 44% e negativo de 85%. Níveis séricos de rs-FNT I foram mais altos nos pacientes que faleceram (1.556 [1.117-1.995]) dos que nos que sobreviveram (759 [555-1.141]); p=0,029. Níveis > 1.230 apresentaram sensibilidade de 79%, especificidade de 75% (valor preditivo positivo 20% e negativo 98%). No modelo de regressão logística multivariada o rs-FNT I (OR = 1,002; IC95% 1,000-1,005; p=0,014) e a idade (OR = 1,083; IC95% 1,010-1,161; p=0,025) se relacionaram independentemente ao risco de evoluçãodesfavorável. Rs-FNT I manteve-se como preditor independente para o óbito (OR = 1,002; IC95% 1,000-1,005; p=0,031). Conclusão: Níveis séricos pré-operatórios elevados de rs- FNT I predizem evolução desfavorável em pacientes que se submetem a revascularizaçãomiocárdica e operações valvares.Objective: The objective of this study was to estimate the sTNF-RI preoperative measure in the identification of patients with good outcome and post-operative cardiac surgery mortality rate. Methods: We assessed prospectively sixty-two patients (47 men- 75.8%) submitted electively to myocardial revascularization with extracorporeal circulation (n=43) or isolated heart valve surgery (n=19). The basal sTNF-RI levels (picograms/milliliters) were determined by the Sandwich-Type ELISA method, at the time of anesthetic induction. Clinical and surgical characteristics and sTNF-RI levels were compared among patients whohad presented good outcome (group I, n=46) or bad outcome (group II, n=16), defined by length of stay in the ICU for over 72 hours or death. Results: No difference was found between the verified mortality (6.4%) and the mortality predicted by EuroSCORE (3.0%), p=0.48. The sTNF-RI levels (pg/ml) were higher in group II (1322 [694-1635]) as comparedto group I (748 [532-1041]) p=0.009 (levels > 954, 69% sensitivity and 70% specificity for favorable development, 44% positive predicted value and 85% negative). The sTNF-RI levels were higher in patients who died (1556 [1117-1995]) than in those who survived (759 [555-1141]) p=0.029, (levels > 1230, 79% sensitivity , 75% specificity , 20% positive predicted value and 98% negative). In the multivariate logistic regression model, sTNF-RI (OR=1.002, IC95% 1.000-1.005, p=0.014) and age (OR=1.083, IC95% 1.010-1.161, p=0.025) were independently related to the risk of unfavorable evolution. STNF-RI remained as an independent predictive agent for death (OR = 1.002, IC95% 1.000-1.005, p=0.031).Conclusions: Basal levels of sTNF-RI yield prognostic information in patients who undergo heart surgery

Tratamento clínico de endocardite em prótese valvar complicada por abscesso para-protético Successful medical management of prosthetic-valve endocarditis complicated by perivalvular abscess

O presente artigo relata o caso de um paciente do sexo masculino, 44 anos, com endocardite em prótese aórtica complicada por abscesso para-protético. Evoluiu com melhora do processo infeccioso apenas com o tratamento clínico. História prévia de doença reumática, submetido a três cirurgias cardíacas para troca valvar por disfunção de prótese e endocardite prévia. Neste relato de caso, discutiremos as características principais do abscesso para-protético como complicação de endocardite<br>We present a case of a 44-year-old man with prosthetic aortic endocarditis complicated by a perivalvular abscess. He evolved with improvement of the infectious process only under clinical treatment. The patient presented a prior history of rheumatic fever and had previously been undergone three valve replacements due to prosthesis dysfunction and previous endocarditis. In this case report we discuss the main features of perivalvular abscess complicating infective endocarditi

Challenge in the management of infective endocarditis with multiple valvular involvement

We describe the case of a 41-year-old man with congenital heart disease and infective endocarditis (IE), who presented multiple vegetations attached to the pulmonary, mitral, and aortic valves. Three valve replacements were performed, but the patient developed an abscess at the mitral-aortic intervalvular fibrosa and died due to sepsis. We briefly discuss the indications for surgery in IE, emphasizing its role in the treatment of uncontrolled infection