HLC 1897 No. of Pages 1
LETTER TO THE EDITOR
Heart, Lung and Circulation (2015) xx, 1 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2015.05.015
Forgotten Predictors of Prosthetic Valve Endocarditis We read with interest the article recently published by Tan et al. entitled ‘‘Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis.’’ [1]. However, we have some concerns about article. Prosthetic valve endocarditis (PVE) is a life-threatening serious condition, despite the major advances made in diagnosis, treatment and management [1]. Treatment options include prolonged antibiotic therapy, repair of prosthetic valve and repeat valve replacement [2]. PVE not only carries a high in-hospital mortality risk but also is associated with high long-term mortality and needs close follow-up. Several factors such as fever at admission, persistent infection, positive blood cultures, Staphylococcus aureus endocarditis, persistently positive cultures, echocardiographic evidence of vegetations or abscess, high creatinine level, poor functional status, urgent surgical treatment, heart failure, thrombocytopaenia and high C-reactive protein measured on admission were found to be associated with hospital mortality in previous studies [2,3]. Tan and colleagues found that Staphylococcus aureus-PVE, presence of shock and intensive care unit admission were associated with in-hospital mortality [1]. The mortality associated with PVE is relatively high, and a rapid diagnosis and prediction of prognosis is essential to facilitate effective treatment. However, identifying patients at increased risk of adverse outcomes is challenging in PVE due to the broad spectrum of the cardiac pathology and infecting microorganisms. Several biomarkers have been examined for their efficacy to predict outcome and assess prognosis of native and PVE patients. Two previous studies showed that B-type natriuretic peptide (BNP) levels obtained on admission are significantly higher in patients with native valve endocarditis who died as compared to survivors [4,5]. These studies revealed that the addition of troponin to BNP provided incremental prognostic value, and patients with native valve endocarditis who had concomitant elevations of troponin and BNP were at particularly high risk for
poor outcomes [4,5]. However, there is no study in the literature evaluating the predictive role of natriuretic peptides and troponin in patients with PVE. Therefore, we would be grateful if the authors would provide the data regarding troponin and BNP levels on admission in patients with PVE. Birdal Yıldırım, MD a,* Funda Sungur Biteker, MD b a Mug˘la Sıtkı Koc¸man University, Faculty of Medicine, Department of Emergency Medicine, Turkey b Mug˘la Sıtkı Koc¸man University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey * ¨ niversitesi Corresponding author. Mug˘la Sıtkı Koc¸man U € Tıp Faku¨ltesi, Orhaniye Mah. Haluk Ozsoy Cad. ˘ LA/TURKEY. Tel.: +90 252 2115210 48000/MUG Email: [email protected] (B. Yıldırım). Received 13 April 2015; accepted 5 May 2015; online published-ahead-of-print xxx
References [1] Tan HL, Chai LY, Yeo TC, Chia BL, Tambyah PA, Poh KK. Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis. Heart Lung Circ 2015 Feb 16. pii: S1443-9506(15)00051-7. http://dx.doi.org/10.1016/j.hlc.2015.01.013. [2] Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol 2014 Sep;30(9):1046–57. [3] Elbey MA, Kalkan ME, Akdag S, Ozbek K, Eren NK, Demirtas S, et al. Predictors of mortality in patients with prosthetic valve infective endocarditis: a nation-wide multicenter study. Cardiol J 2013;20(3):323–8. http://dx.doi.org/10.5603/CJ.2013.0079. [4] Shiue AB, Stancoven AB, Purcell JB, Pinkston K, Wang A, Khera A, et al. Relation of level of B-type natriuretic peptide with outcomes in patients with infective endocarditis. Am J Cardiol 2010;106:1011–5. 392–24. [5] Kahveci G, Bayrak F, Mutlu B, Bitigen A, Karaahmet T, Sonmez K, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis. Am J Cardiol 2007;99:1429–33.
© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Yıldırım B, Biteker FS. Forgotten Predictors of Prosthetic Valve Endocarditis. Heart, Lung and Circulation (2015), http://dx.doi.org/10.1016/j.hlc.2015.05.015
LETTER TO THE EDITOR
Heart, Lung and Circulation (2015) xx, 1 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2015.05.015
Forgotten Predictors of Prosthetic Valve Endocarditis We read with interest the article recently published by Tan et al. entitled ‘‘Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis.’’ [1]. However, we have some concerns about article. Prosthetic valve endocarditis (PVE) is a life-threatening serious condition, despite the major advances made in diagnosis, treatment and management [1]. Treatment options include prolonged antibiotic therapy, repair of prosthetic valve and repeat valve replacement [2]. PVE not only carries a high in-hospital mortality risk but also is associated with high long-term mortality and needs close follow-up. Several factors such as fever at admission, persistent infection, positive blood cultures, Staphylococcus aureus endocarditis, persistently positive cultures, echocardiographic evidence of vegetations or abscess, high creatinine level, poor functional status, urgent surgical treatment, heart failure, thrombocytopaenia and high C-reactive protein measured on admission were found to be associated with hospital mortality in previous studies [2,3]. Tan and colleagues found that Staphylococcus aureus-PVE, presence of shock and intensive care unit admission were associated with in-hospital mortality [1]. The mortality associated with PVE is relatively high, and a rapid diagnosis and prediction of prognosis is essential to facilitate effective treatment. However, identifying patients at increased risk of adverse outcomes is challenging in PVE due to the broad spectrum of the cardiac pathology and infecting microorganisms. Several biomarkers have been examined for their efficacy to predict outcome and assess prognosis of native and PVE patients. Two previous studies showed that B-type natriuretic peptide (BNP) levels obtained on admission are significantly higher in patients with native valve endocarditis who died as compared to survivors [4,5]. These studies revealed that the addition of troponin to BNP provided incremental prognostic value, and patients with native valve endocarditis who had concomitant elevations of troponin and BNP were at particularly high risk for
poor outcomes [4,5]. However, there is no study in the literature evaluating the predictive role of natriuretic peptides and troponin in patients with PVE. Therefore, we would be grateful if the authors would provide the data regarding troponin and BNP levels on admission in patients with PVE. Birdal Yıldırım, MD a,* Funda Sungur Biteker, MD b a Mug˘la Sıtkı Koc¸man University, Faculty of Medicine, Department of Emergency Medicine, Turkey b Mug˘la Sıtkı Koc¸man University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey * ¨ niversitesi Corresponding author. Mug˘la Sıtkı Koc¸man U € Tıp Faku¨ltesi, Orhaniye Mah. Haluk Ozsoy Cad. ˘ LA/TURKEY. Tel.: +90 252 2115210 48000/MUG Email: [email protected] (B. Yıldırım). Received 13 April 2015; accepted 5 May 2015; online published-ahead-of-print xxx
References [1] Tan HL, Chai LY, Yeo TC, Chia BL, Tambyah PA, Poh KK. Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis. Heart Lung Circ 2015 Feb 16. pii: S1443-9506(15)00051-7. http://dx.doi.org/10.1016/j.hlc.2015.01.013. [2] Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol 2014 Sep;30(9):1046–57. [3] Elbey MA, Kalkan ME, Akdag S, Ozbek K, Eren NK, Demirtas S, et al. Predictors of mortality in patients with prosthetic valve infective endocarditis: a nation-wide multicenter study. Cardiol J 2013;20(3):323–8. http://dx.doi.org/10.5603/CJ.2013.0079. [4] Shiue AB, Stancoven AB, Purcell JB, Pinkston K, Wang A, Khera A, et al. Relation of level of B-type natriuretic peptide with outcomes in patients with infective endocarditis. Am J Cardiol 2010;106:1011–5. 392–24. [5] Kahveci G, Bayrak F, Mutlu B, Bitigen A, Karaahmet T, Sonmez K, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis. Am J Cardiol 2007;99:1429–33.
© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Yıldırım B, Biteker FS. Forgotten Predictors of Prosthetic Valve Endocarditis. Heart, Lung and Circulation (2015), http://dx.doi.org/10.1016/j.hlc.2015.05.015
