Papers by Cristina Sarriá
Clinical Microbiology Newsletter, 2011
Expert Review of Cardiovascular Therapy, 2015
Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and progn... more Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.
Journal of the American College of Cardiology, 2015
Research in different topics in cardiovascular medicine is evolving rapidly. However, this is not... more Research in different topics in cardiovascular medicine is evolving rapidly. However, this is not the case for endocarditis, despite its being the cardiovascular disease with the highest mortality and, at the same time, the entity with relatively less scientific evidence supporting its treatment. Many problems are delaying research: it is an uncommon disease, few multicenter registries are ongoing, financing for research in this topic is lacking, randomization is costly, difficult, and considered unethical by some, and conclusions coming from propensity score analysis are taken as if they came from randomized trials. In this review, we put forward the main issues in need of evidence and propose a different approach to advance the understanding of left-sided infective endocarditis. We summarize the limited evidence available, the questions that are pending, and how we should proceed to answer them.
International Journal of Cardiology, 2015
The American Journal of Cardiology, 2015
In-hospital mortality of patients with infective endocarditis (IE) remains exceedingly high. Quic... more In-hospital mortality of patients with infective endocarditis (IE) remains exceedingly high. Quick recognition of parameters accurately identifying high-risk patients is of paramount importance. The objective of this study was to analyze the incidence and severity of thrombocytopenia at presentation and its prognostic impact in patients with native valve left-sided IE. We studied a cohort of 533 consecutive episodes of native valve left-sided IE prospectively recruited. We distinguished 2 groups: group I (n = 175), episodes who had thrombocytopenia at admission, and group II (n = 358) gathered all the episodes who did not. Thrombocytopenia at admission was defined as a platelet count of <150,000/μl. No differences were found in the need for surgery, but in-hospital mortality was significantly higher in patients with thrombocytopenia (p <0.001). Mortality rate was associated with the degree of thrombocytopenia (p <0.001). In the multivariable analysis, thrombocytopenia at admission was an independent predictor of higher mortality (p = 0.002). A synergistic interaction between thrombocytopenia and Staphylococcus aureus on mortality risk was also observed (p = 0.04). In conclusion, thrombocytopenia at admission is an early risk marker of increased mortality in patients with native valve left-sided IE. Mortality rates increased with increasing severity of thrombocytopenia. Thrombocytopenia at admission should be used as an early marker for risk stratification in patients with native valve IE to identify those at risk of complicated in-hospital evolution and increased mortality.
International journal of cardiology, Jan 28, 2014
Revista Española de Cardiología, 2009
Introducción y objetivos. La endocarditis protésica conlleva una alta morbimortalidad, más aún si... more Introducción y objetivos. La endocarditis protésica conlleva una alta morbimortalidad, más aún si precisa cirugía urgente. Determinar los factores predictores de mal pronóstico es el primer paso para disminuirla. Nuestro objetivo es definir el perfil de los pacientes con ...
The American Journal of Cardiology, 2014
Native valve infective endocarditis (IE) in patients with normal valves has increased in the last... more Native valve infective endocarditis (IE) in patients with normal valves has increased in the last decades. Whether patients with normal valves present a similar prognosis to those with pathologic valves is unresolved. Our aim is to describe epidemiologic and clinical differences between patients with left-sided IE and normal valves and those with native pathologic valves. We analyzed 945 consecutive episodes of IE, 435 of which involved left-sided nonprosthetic IE. They were classified into 2 groups: episodes in normal valves (normal group, n=173) and episodes in pathologic valves (abnormal group, n=262). Patients in the normal group were younger, Staphylococcus aureus and Streptococcus bovis were more frequently isolated, and vegetations were more frequently found. Heart failure, septic shock, and the need for surgery or death were more common. Multivariate analysis identified the following as factors independently associated with normal valve IE: age<65 years, S bovis, S aureus, heart failure, and vegetation detection. Factors independently associated with in-hospital events included S aureus, periannular complications, heart failure, and septic shock development. In conclusion, compared with patients with abnormal valve IE, patients with IE on normal valves were younger, had a more virulent microbiological profile, developed heart failure and septic shock more frequently, needed more surgical procedures, and had worse prognosis.
Revista Española de Cardiología (English Edition), 2012
Left-sided infective endocarditis with blood culture-negative has been associated with delayed di... more Left-sided infective endocarditis with blood culture-negative has been associated with delayed diagnosis, a greater number of in-hospital complications and need for surgery, and consequently worse prognosis. The aim of our study was to review the current situation of culture-negative infective endocarditis. We analyzed 749 consecutive cases of left-sided infective endocarditis, in 3 tertiary hospitals from June 1996 to 2011 and divided them into 2 groups: group I (n=106), blood culture-negative episodes, and group II (n=643) blood culture-positive episodes. We used Duke criteria for diagnosis until 2002, and its modified version by Li et al. thereafter. Age, sex, and comorbidity were similar in both groups. No differences were found in the proportion of patients who received antibiotic treatment before blood culture extraction between the 2 groups. The interval from symptom onset to diagnosis was similar in the 2 groups. The clinical course of both groups during hospitalization was similar. There were no differences in the development of heart failure, renal failure, or septic shock. The need for surgery (57.5% vs 55.5%; P=.697) and mortality (25.5% vs 30.6%; P=.282) were similar in the 2 groups. Currently, previous antibiotic therapy is no longer more prevalent in patients with blood culture-negative endocarditis. This entity does not imply a delayed diagnosis and worse prognosis compared with blood culture-positive endocarditis. In-hospital clinical course, the need for surgery and mortality are similar to those in patients with blood culture-positive endocarditis. Full English text available from:www.revespcardiol.org.
Revista Española de Cardiología, 2011
The objective was to describe the vegetation changes in patients with endocarditis and evaluate t... more The objective was to describe the vegetation changes in patients with endocarditis and evaluate their prognostic importance during hospitalization. We selected patients with left-sided endocarditis and two transesophageal echocardiograms separated by at least 8 days. Patients who required surgery or died during the first week after diagnosis of the disease were excluded. Patients were classified into three groups: I, patients whose vegetation increased in size (n=34); II, patients with vegetations that did not vary in size (n=62); and III, patients whose vegetation decreased in size (n=59). Patients whose vegetation increased in size more frequently required surgery. Multivariate analysis showed that the increase in the vegetation is independently associated with increased mortality: adjusted odds ratio, 4.12 (95% confidence interval, 1.14-14.9; P=.031).
Revista Española de Cardiología (English Edition), 2013
There have been no studies conducted in the past that focus on the significance of congestive hea... more There have been no studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies. A total of 639 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 257 were prosthetic. Of the 257 episodes, 145 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis and identified the prognostic factors of in-hospital mortality in these patients. Persistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0.2; 95% confidence interval, 0.1-0.5). The incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.
Revista Española de Cardiología, 2010
ABSTRACT In many cardiovascular and infectious diseases, there are clinical and prognostic differ... more ABSTRACT In many cardiovascular and infectious diseases, there are clinical and prognostic differences between men and women. The aim of this study was to compare the presentation of left-sided infective endocarditis in the two sexes. A total of 621 episodes of left-sided infective endocarditis (395 in men, 226 in women) were studied. The comparative analysis considered epidemiological, clinical, microbiological, echocardiographic and prognostic variables. Despite marked epidemiological, echocardiographic and microbiological differences between men and women, clinical characteristics, treatment approaches and outcomes (in-hospital mortality: 28% in men and 35% in women; P=.1) were similar in our patient series.
Revista Española de Cardiología, 2008
... Ana Revilla a , Javier López a , Eduardo Villacorta a , Itziar Gómez a , Teresa Sevilla a , M... more ... Ana Revilla a , Javier López a , Eduardo Villacorta a , Itziar Gómez a , Teresa Sevilla a , Miguel Ángel del Pozo b , Luis de la Fuente a ... El estudio de Naidoo 9 analizó 15 casos de endocarditis derecha en pacientes sin ADVP; sin embargo, se trata de un análisis retrospectivo en ...
Revista Española de Cardiología (English Edition), 2013
Revista Española de Cardiología, 2013
Revista Española de Cardiología, 2011
Uno de los cambios má s notables que se han producido en la epidemiología de la endocarditis infe... more Uno de los cambios má s notables que se han producido en la epidemiología de la endocarditis infecciosa (EI) en los países desarrollados las ú ltimas dé cadas es el aumento progresivo de la proporció n de pacientes ancianos con esta enfermedad 1 . El objetivo de este amplio estudio prospectivo es definir la forma de presentació n clínica actual, los factores de riesgo predisponentes, los agentes microbioló gicos, los hallazgos ecocardiográ ficos y la evolució n clínica de los pacientes octogenarios (edad ! 80 añ os) con EI, en comparació n con los individuos de menor edad.
Clinical Microbiology Newsletter, 2011
Journal of the American College of Cardiology, 2002
This study was designed to assess the risk of systemic embolization in patients with left-sided i... more This study was designed to assess the risk of systemic embolization in patients with left-sided infective endocarditis, once adequate antibiotic treatment had been initiated, on the basis of prospective clinical follow-up. BACKGROUND As one of the complications of infective endocarditis, embolization has a great impact on prognosis. Prediction of an individual patient's risk of embolization is very difficult.
International Journal of Antimicrobial Agents, 2009
Background: Sternal wound infection (SWI) including mediastinitis after cardiac surgery is a seri... more Background: Sternal wound infection (SWI) including mediastinitis after cardiac surgery is a serious cardiovascular infection with high reported mortality. Intraoperative prophylaxis with intravenous betalactam antibiotics is recommended and routinely applied. However, an increasing proportion of these infections are caused by staphylococci resistant to beta-lactam antibiotics. In a previous randomized controlled trial (LOGIP-trial) the addition of locally applied collagengentamicin reduced the incidence of postoperative sternal wound infections compared with intravenous prophylaxis only. Subsequently the technique with local gentamicin was introduced in clinical routine at our centres. The aim of the present study, the LOGIX-trial (ClinicalTrials.gov NCT00484055) was to re-evaluate the technique regarding a sustained effect on wound infections and potential shifts in microbiological findings over time. Methods: In this prospective two-centre study all patients undergoing cardiac surgery via median sternotomy received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to the routine intravenous antibiotics. The incidences of deep and superficial SWI within 60 days postoperatively were recorded and compared with the previous control group without local collagen-gentamicin. Results: From Jan 2007 to May 2008 1359 patients were included. The total incidence of SWI was 3.7%. The incidences of all SWI and of deep SWI were significantly reduced compared with the control group, also after correction for other risk factors (OR = 0.34 for deep SWI, P < 0.001). The majority of SWI were caused by coagulase-negative staphylococci (CoNS), of which 80% were resistant to methicillin. Also 80% of the CoNS were resistant to aminoglycosides (gentamicin or tobramycin), but there was no increase in the absolute incidence of aminoglycoside resistant agents compared with the previous study. The incidence of SWI caused by S. aureus was 0.4% (0.07% deep SWI).
Heart, 2011
Early identification of prognostic factors is essential to improve the grim prognosis associated ... more Early identification of prognostic factors is essential to improve the grim prognosis associated with left-sided infective endocarditis. This group identified three independent risk factors obtained within 72 h of admission, (Staphylococcus aureus, heart failure and periannular complications) for inhospital mortality or urgent surgery in a series of 317 patients diagnosed at five tertiary centres (derivation sample). A stratification score was constructed for the test cohort by a simple arithmetic sum of the number of variables present. The goal was to validate this model internally and externally in a prospective manner with two different cohorts of patients. The appropriateness of the model was tested prospectively on predicting events in two cohorts of patients with left-sided endocarditis: internally with the 263 consecutive patients diagnosed at the same centres where the model was derived (internal validation sample), and externally with 264 patients admitted at another hospital (external validation sample). The discriminatory power of the model, expressed as the area under the receiver operating characteristic curve was similar between derivation and both validation samples (internal 0.67 vs 0.68, p=0.79; external 0.67 vs p=0.74, p=0.09). There was a progressive, significant pattern of increasing event rates as the risk stratification score increased in both validation cohorts (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 by χ² for trend). The early risk stratification model derived, based on variables obtained within 72 h of admission, is applicable to different populations with left-sided endocarditis. A simple bedside assessment tool is provided to clinicians that identifies patients at high risk of having an adverse event.
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Papers by Cristina Sarriá