Elías Romo

Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987–2013)

AIMSnUse of cardiac pacing devices has grown in recent years. Our aim was to evaluate changes in epidemiology and clinical features of infective endocarditis (IE) involving pacemaker devices in a large series of IE over the last 27 years (1987-2013).nnnMETHODS AND RESULTSnFrom 1987 to December 2013, 413 consecutive IE cases were diagnosed in our hospital. During this period, 7424 pacemaker devices were implanted (6917 pacemakers, 239 implantable cardiac defibrillators, 158 resynchronization devices, and 110 resynchronization/defibrillator devices). All consecutive cases of IE on pacemaker devices were included and analysed. Infective endocarditis on pacemaker devices represented 6.1% of all endocarditis cases (25 patients), affecting 3.6/1000 of all implanted pacemakers. Its proportion increased from 1.25% of all endocarditis in 1987-1993 to 4.08% in 1994-2000, 7.69% in 2001-2007 and 9.32% in 2008-2013 (P < 0.01). Its incidence also increased from 1.4/1000 of all pacemaker implants in the period of 1987-1993 to 2.5/1000 in 1994-2000, 3.3/1000 in 2001-2007 and 4.5/1000 implanted devices in 2008-2013 (P < 0.05). Mean age of patients was 68 years, and 80% were male. Causative microorganisms predominantly were Staphylococci (84%: Staphylococcus aureus 48%, Staphylococcus epidermidis 36%). Rate of severe complications was high: persistent sepsis in 60% of cases, heart failure in 20%, and stroke in 12%. Device was removed in 19 patients (76%), mostly by surgery (18 of the 19 cases). Early mortality was 24% (33% of medically, 21% of surgically treated patients, P = 0.82).nnnCONCLUSIONnInfective endocarditis on pacemaker devices has shown an increasing incidence during the past decades, representing almost 10% of all IE in the last 6 years. This is a severe disease, with a high rate of severe complications and requiring removal of device in most cases. In spite of therapy, early mortality is high.

Outcomes and Safety of Antithrombotic Treatment in Patients Aged 80 Years or Older With Nonvalvular Atrial Fibrillation

Our aim was to evaluate the effectiveness of oral anticoagulation (OAC) in patients aged ≥80 years with nonvalvular atrial fibrillation in daily clinical practice. From February 1, 2000 to June 30, 2009, we enrolled all patients aged ≥80 years with nonvalvular atrial fibrillation attended at 2 outpatient cardiology clinics of a tertiary care university hospital. The patients received antithrombotic treatment according to the recommendations from scientific societies and were prospectively followed, with major events (i.e., all-cause death, stroke, transient ischemic attack, peripheral embolism, severe bleeding) analyzed according to the treatment group (OAC vs no OAC). Of 269 patients included in the present study (87 men, mean age 83 ± 3 years), 164 received OAC (61%). After 2.8 ± 1.9 years of follow-up, the raw rates (per 100 patient-years) of embolic events (1.52% vs 8.30%, p <0.0001) and mortality (6.67% vs 10.94%, p = 0.04) were lower for patients receiving OAC, with a nonsignificant greater rate of severe bleeding (3.03% vs 1.25%, p = 0.14). The probability of survival free of major embolic or hemorrhagic events at the mean follow-up was greater for patients receiving OAC (82.27% vs 66.10%, p = 0.004). After adjustment for age, gender, coronary heart disease, and embolic risk, evaluated using the CHADS(2) score (congestive heart failure, 1 point; hypertension [blood pressure consistently >140/90 mm Hg or hypertension medication], 1 point; age ≥75 years, 1 point; diabetes mellitus, 1 point; previous stroke or transient ischemic attack, 2 points), only OAC was an independent predictor of embolic events (hazard ratio 0.17, 95% confidence interval 0.07 to 0.41, p <0.001). The CHADS(2) score (hazard ratio 1.32, 95% confidence interval 1.01 to 1.73, p = 0.04) and OAC (hazard ratio 0.52, 95% confidence interval 0.31 to 0.88, p = 0.01) were independent predictors of mortality. In conclusion, OAC according to the scientific societies recommendations is effective and safe in daily clinical practice, even in patients aged ≥80 years.

Impact of Asymptomatic Acute Cellular Rejection on Left Ventricle Myocardial Function Evaluated by Means of Two‐Dimensional Speckle Tracking Echocardiography in Heart Transplant Recipients

Our objective was to evaluate the impact of asymptomatic acute cellular rejection (ACR) in left ventricular myocardial strain in heart transplant (HT) recipients by means of two‐dimensional speckle tracking echocardiography (2DSTE).

Long-term survival in elderly patients with stable coronary disease

This study aimed to assess long‐term prognosis of stable coronary artery disease (sCAD) in patients aged ≥ 75 years and to identify clinical predictors of cardiovascular and overall mortality.

Prognostic Impact of Baseline Low Blood Pressure in Hypertensive Patients With Stable Coronary Artery Disease of Daily Clinical Practice

J Clin Hypertens (Greenwich). 2012;00:00–00 ©2012 Wiley Periodicals, Inc.

Normal values of classical and new parameters of right ventricular function in the absence of rejection in the first year post heart transplantation

Purpose: Our objective is to describe normal values of right ventricular systolic function echocardiographic parameters, evaluated by means of conventional and two-dimensional speckle tracking echocardiography (2DSTE) in the first year after heart transplantation (HT), in the absence of acute cellular rejection.nnMethods: From September 1st, 2009 to December 14th, 2010 we performed an exhaustive echocardiographic exam in all transplant recipients during their first post-transplantation year within the same day of the routine endomyocardial biopsies. We selected the exams that were coincident with no acute cellular rejection (grade 0R). Tricuspid annular plane systolic excursion (TAPSE) measured with M-mode and 2DSTE, tricuspid annular lateral systolic velocity measured by Tissue Doppler Imaging (S wave), right ventricular strain and strain rate, evaluated by means of 2DSTE, were obtained in all of them, and compared with 14 healthy controls.nnResults: 32 studies performed 4±3 months after heart transplantation in 14 patients showed absence of acute cellular rejection (grade 0R). The mean age was similar in donors and controls (35±14 versus 35±11, p=0,93) and higher in transplant recipients than in controls (50±15 versus 35±11, p=0,005). Male gender percentage was similar in donors versus controls (85% versus 71%, p=0,41) and in transplanted patients versus controls (93% versus 71%, p=0,14). Right ventricular function parameters in the transplanted group compared to controls were: TAPSE (M-mode) 15,7±2,7 versus 23,5±1,7 (p<0,0005), S wave 11,8±1,8 versus 15,3±1,9 (p=0,005), TAPSE (2DSTE) 11,0±3,1 versus 21,2±3,6 (p<0,0005), right ventricular strain -25,1±9,2 versus -29,5±6,9 (p=0,29) and right ventricular strain rate -2,2±1,0 versus -2,9±1,7 (p=0,35).nnConclusion: In the first year post-HT, and in the histologically proven absence of rejection, we found significantly lower values of TAPSE measured with M-mode and 2DSTE and S wave in transplanted patients versus controls, and non-significantly lower values of right ventricular strain and strain rate, evaluated by means of 2DSTE.