| Diagnosis of cardiac device-related infective endocarditis after device removal. | |
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MedLine Citation:
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PMID: 20633844 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to determine the incidence, diagnostic value, and outcome of intracardiac masses observed by echocardiography after device removal. We hypothesized that these "ghosts" of leads could be associated with the diagnosis of cardiac device-related infective endocarditis (CDRIE). BACKGROUND: The echocardiographic appearance of residual floating masses in the right atrium after removal of permanent pacemakers and implantable cardioverter-defibrillators was recently described. However, the significance of these ghosts and their relationship with CDRIE are unknown. METHODS: The pre-operative clinical, microbiological, and echocardiographic conditions; the indication; and the removal technique were analyzed in a retrospective cohort including all consecutive patients who underwent percutaneous lead removal. Three groups were formed according to the final diagnosis: CDRIE, local device infection, and noninfectious indications. The incidence of ghosts was compared among the 3 groups. All clinical, infectious, and extraction-related factors were studied for their association with ghosts. All patients with ghosts were followed after hospitalization. RESULTS: Two hundred twelve patients underwent lead removal. Ghosts were observed in 17 patients (8% incidence), including 14 (16%) of 88 patients with CDRIE and 3 (5%) of 59 patients with local device infection. Ghosts were never observed among the remaining 65 noninfected patients. A significant association was found between CDRIE and the presence of a ghost (odds ratio: 7.63, 95% confidence interval: 2.12 to 27.45, p = 0.001). At 3 months, 2 patients with ghosts died suddenly, 2 underwent surgery, and 1 had a pulmonary embolism. CONCLUSIONS: Ghosts are observed in 8% of patients after percutaneous device extraction. Their presence is suggestive of device infection and seems to be associated with the diagnosis of CDRIE. The prognostic significance of such findings needs further investigation. |
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Authors:
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Yvan Le Dolley; Franck Thuny; Julien Mancini; Jean-Paul Casalta; Alberto Riberi; Frédérique Gouriet; Emilie Bastard; Sebastien Ansaldi; Frederic Franceschi; Sebastien Renard; Sebastien Prevot; Roch Giorgi; Laurence Tafanelli; Jean-François Avierinos; Didier Raoult; Jean-Claude Deharo; Gilbert Habib |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular imaging Volume: 3 ISSN: 1876-7591 ISO Abbreviation: JACC Cardiovasc Imaging Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-16 Completed Date: 2010-11-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101467978 Medline TA: JACC Cardiovasc Imaging Country: United States |
Other Details:
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Languages: eng Pagination: 673-81 Citation Subset: IM |
Copyright Information:
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Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiology, La Timone Hospital, Marseille, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Chi-Square Distribution Defibrillators, Implantable / adverse effects* Device Removal* Echocardiography, Transesophageal* Endocarditis / epidemiology, microbiology, therapy, ultrasonography* Female France Humans Incidence Logistic Models Male Middle Aged Odds Ratio Pacemaker, Artificial / adverse effects* Predictive Value of Tests Prosthesis-Related Infections / epidemiology, microbiology, therapy, ultrasonography* Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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