RESUMEN
BACKGROUND: To evaluate the prognostic impact of diabetes mellitus (DM) in patients with Infective Endocarditis (IE). METHODS AND RESULTS: 375 patients with diagnosis of IE referred to our Hospital between 1994-2017 were retrospectively included; diabetes was reported in 129 (34.4%). Diabetic patients were older than non-diabetic (66±1 vs. 57±2 years, p<0.001) and showed a higher prevalence of comorbidities such as hypertension (75 vs. 54%, p<0.001), coronary artery disease (30 vs. 12%, p<0.001) and history of heart failure (HF; 24 vs. 13%, p = 0.021). Echocardiography showed a higher incidence of paravalvular complications (82 vs. 64%, p<0.001) and a lower left ventricular ejection fraction (LVEF; 52±11 vs. 55±10%, p = 0.001) in diabetic than in non-diabetic patients. In-hospital mortality was higher in diabetic patients (83 vs. 74%; p = 0.030). At logistic regression, history of HF (OR = 3.1, 95%CI: 1.87-5.29, p<0.001) resulted an independent predictor of in-hospital death. At long-term follow-up [median 24(7-84) months], the Kaplan-Meier analysis showed a significantly lower survival free from all-cause death in the group with diabetes (Log-rank<0.001). At the propensity score adjusted Cox multivariable analysis, DM (HR = 1.76, 95%CI: 1.18-2.6, p = 0.005), age (HR = 1.03, 95%CI: 1.02-1.05, p<0.001), intravenous drug users (HR = 5.42, 95%CI: 2.55-11.51, p<0.001) and low LVEF (HR = 0.98, 95%CI: 0.96-0.99, p = 0.013) were independently associated to a higher mortality. CONCLUSION: In patients with IE, DM is associated to a higher prevalence of anatomic complications and a more impaired LVEF. Diabetic patients show a significantly lower survival both in hospital and during follow-up compared to the non-diabetic ones.
Asunto(s)
Complicaciones de la Diabetes/epidemiología , Endocarditis/complicaciones , Adulto , Anciano , Comorbilidad , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/fisiopatología , Endocarditis/epidemiología , Endocarditis/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Italia/epidemiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Retrospectivos , Función Ventricular IzquierdaRESUMEN
Pheochromocytoma can occur with a variety of cardiovascular signs and symptoms, and this tumor can also precipitate an acute heart failure associated with the typical clinical and instrumental findings of myocarditis. This peculiar etiology of acute myocarditis, known as "adrenergic myocarditis," should be suspected when specific "red flags" of pheochromocytoma such as headache, palpitations, diaphoresis, hypertension, orthostatic hypotension, and left ventricular dysfunction suggesting Takotsubo syndrome are detected. In fact, its diagnosis allows a specific targeted therapy.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Insuficiencia Cardíaca/etiología , Miocarditis/etiología , Feocromocitoma/complicaciones , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/cirugía , Diagnóstico Diferencial , Diagnóstico por Imagen , Servicio de Urgencia en Hospital , Humanos , Masculino , Feocromocitoma/diagnóstico , Feocromocitoma/cirugía , Adulto JovenRESUMEN
We present a case of a 67-year-old male with pulmonary embolism. Transesophageal echocardiography (TEE) showed the presence of a mobile thrombus straddling the patent foramen ovale (PFO) and prolapsing into both atria. Treatment with heparin was started. Five days after admission, repeat TEE revealed a reduction in thrombus dimensions, so anticoagulation therapy was continued. Eleven days after admission, TEE showed complete disappearance of the thrombus.
Asunto(s)
Acenocumarol/uso terapéutico , Anticoagulantes/uso terapéutico , Ecocardiografía Transesofágica , Foramen Oval Permeable/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Heparina/uso terapéutico , Embolia Pulmonar/diagnóstico , Trombosis/diagnóstico por imagen , Acenocumarol/administración & dosificación , Anciano , Anticoagulantes/administración & dosificación , Quimioterapia Combinada , Estudios de Seguimiento , Heparina/administración & dosificación , Humanos , Masculino , Embolia Pulmonar/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Trombosis/etiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We report the case of a 71-year-old man hospitalized for acute heart failure. Transthoracic and transesophageal echocardiography showed mitral valve aneurysm (MVA) rupture and severe mitral regurgitation. No vegetations but significant aortic regurgitation were also observed. MVA perforation is a rare life-threatening condition that typically occurs as a complication of endocarditis but may also be associated with other diseases, in particular connective tissue disorders. In the present case, the absence of such etiology suggests a possible role for of aortic regurgitation in MVA rupture secondary to a "jet lesion" mechanism.