Infective endocarditis

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Slide 1 :

Epidemiology, Clinical Characteristics and Evolution of Infective Endocarditis in Under-developed Countries: Results of the Argentinian Registries (EIRA) Dr J Horacio Casabé MD, PhD , FACC, MTSAC Fundación Favaloro, Buenos Aires, Argentina World Congress of Cardiology May 18-21 2008 Buenos Aires, Argentina Nothing to disclose

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The first National survey of IE in Argentina (EIRA-1) was conducted between 1992 and 1993 EIRA Studies Background It was the first multicenter survey done in an underdeveloped country and was published in the Revista Argentina de Cardiologia JH Casabé, CD Pellegrini, AR Hershson, MS Ramos, L Vidal, EA Sampó JL Barisani, L Clara, EA Argüello y SD Varini.Endocarditis Infecciosa en la Republica Argentina. Resultados generales. Rev Argent Cardiol 1996; (Suplemento V):9-19.

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EIRA 1

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Multicenter study (33) with 294 episodes in 285 patients according to Duke Criteria included in 18 months 55% had underlying heart disease 63.3% predisposing event ;40 cases (13%)of drug abuse 23,5 % of Hospital Mortality EIRA 1

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EIRA 1 Symptoms EIRA 1 Symptoms

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EIRA 1 Signs EIRA 1 Signs

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EIRA 1 IV Drug abuse patients Rev Argent Cardiol 1996;64: 27-32

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EIRA 1 IV Drug abuse patients Rev Argent Cardiol 1996;64: 27-32

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EIRA 1 IV Drug abuse patients Rev Argent Cardiol 1996;64: 27-32

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Surgical Treatment EIRA 1

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After 10 years, in 2002-2003 with the objective of determine the epidemiologic, clinical, microbiologic characteristics, and inhospital outcome of IE in Argentina and compare the results with the 1992 IE national survey ,the Argentinian Society of Cardiology (SAC) decided to do a new multicenter Survey: the EIRA 2 study EIRA Studies Rational

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Am Heart J 2006;151:545-52

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EIRA 2. Representativity Euro Heart Survey159 cases in 92 centres from 25 countries in 1 year (Heart 2005) French Registry : 26% territory of France, 290 patients (JAMA 2002) International Collaboration on Endocarditis Group(ICE) 1779 EI definite patients during 4 years in 39 centres from16 countries.Average: 111 cases/country/4 years or 28 cases/country/year (JAMA 2005) Endocarditis Infecciosa en la República Argentina(EIRA 2) . > 75% national territory. Average : 260 cases/year (Am Heart J 2006)

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EIRA-1 EIRA-2 Nº episodes 294 470 N° Definite IE 75,5% 83,0% Age in years (average) 51,3 58,5* Male sex 69,5% 70,0% Underlying heart disease 55% 66,2%* Pathologic confirmation(%) 20,7% 29,2% Diabetes (%) ND 14,6% Previous IE(%) 10,2% 11,3% Previous heart surgery(%) ND 20,8% COPD (%) ND 4,4% Chronic renal failure ND 14,2% EIRA Studies Basal Characteristics * p < 0,01

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% EIRA Studies Underlying heart disease

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Microorganisms Negative blood cultures: EIRA 1: 20,4 ; EIRA 2: 17,7% EIRA Studies %

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Valve involvement % * p < 0,01 * EIRA Studies

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Time to diagnosis 33,07 ± 34,3 days 21,5 ± 35,3 days p < 0,001 EIRA Studies

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Evolution: Complications % * p < 0,01 * EIRA Studies

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Evolution: Surgery and Mortality % p = NS EIRA Studies

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EIRA Studies S aureus Infective endocarditis

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% SAIE 108 episodes (30%) vs. NSAIE 282 episodes * p < 0,01 * * * Age SAIE 57,0±17 vs 59,0±17; p = 0,05 EIRA. S aureus Underlying diseases

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EIRA. S aureus Predisposing factors and concomitant diseases % * p < 0,01 * * * *

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33,3% TTE / 66,6% TTE + TEE EIRA. S aureus Echocardiogram % Vegetation size(mm) SAIE 17,5 ± 10,1 vs NSAIE 12,7 ± 10,7; p=0,03

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EIRA. S aureus Localization % * p < 0,01 * *

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EIRA. S aureus IE Evolution: Complications % * p < 0,01 ** p = 0,14 * * * **

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EIRA. S aureus IE Surgery Indications % * p = 0,001 ** p = NS * ** **

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EIRA. S aureus Surgery and Mortality % OR 0,6 (IC 95% 0,36-1,2) p=NS OR 2,0 (IC 95% 1,2-3,3) p=0,009

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Increase of S aureus as etiologic agent

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Clin Infect Dis 2005;41:507-514 Increase of S aureus as etiologic agent

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Increase of S aureus as etiologic agent

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In the last 10 years clinical profile of IE has changed in Argentina Currently patients are older (7 years) and have a higher frequency of underlying heart disease, degenerative valve disease,and prosthetic valve. Intravascular catheters and predisposing factors are more prevalent than previously There is an increase of congenital heart disease and a decrease of rheumatic heart disease as underlying heart disease in the group of patients aged < 40 years . EIRA Studies : Conclusions (1)

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The incidence of S aureus IE has increased.; it was an inversion in the prevalence(S viridans : S aureus) Patients with S aureus IE have a high risk profile and worse hospital evolution (more embolism, CVA, septic shock and mortality) Despite advances in surgical treatment and earlier time to diagnosis,the incidence of complications and mortality has not been reduced EIRA Studies : Conclusions (2)

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EIRA Studies : Conclusions (3) One likely explanation for the absence of a positive correlation with better outcome might be the higher risk profile of the EIRA-2 patient (older population, higher prevalence of valve prostheses,increased proportion of staphylococci IE). Hypothesis

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Participant Provinces: 16 Medical Centers: 146 EIRA Studies Acknowledgments Coordinating Center Mario Ciruzzi, Ernesto Ferreirós, Sandra Swieszkowski, Juan Carlos Modenesi, Francisco Nacinovich, José H. Casabé y Sergio Varini. Regional Coordinators Hernán Cohen Arazi, Adriana Angel, Cecilia Zevallos, Lucía Kazelian, Claudia Cortés, Román Cragnolino, Mariano Falconi, Alejandra Francesia, Mariano Giorgi, Claudio Higa, Pablo Schygiel, Alejandra von Wulffen.

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EIRA Studies Thank you for your attention Lago Gutierrez, Bariloche, Argentina

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