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1. F-18-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material

Author

Pizzi, MN, Dos-Subira, L, Roque, A, Fernandez-Hidalgo, N, Cuellar-Calabria, H, Domenech, AP, Gonzalez-Alujas, MT, Subirana-Domenech, MT, Miranda-Barrio, B, Ferreira-Gonzalez, I, Gonzalez-Lopez, JJ, Igual, A, Maisterra-Santos, O, Garcia-Dorado, D, Castell-Conesa, J, Almirante, B, Amores, ME, Tornos, P, and Aguade-Bruix, S

Subjects
Adult, Cardiac computed tomography, Congenital cardiac disease, Prosthetic material, cardiovascular diseases, Infective endocarditis, F-18-FDG-PET/CT
Abstract

Objectives: Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of F-18-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients' complex anatomy. Methods: A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (>= 18 years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC + PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. Results: Between November-2012 and April-2017, 25 patients (15 men; median age 40 years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC + PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. Conclusions: PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification. (C) 2017 Elsevier B.V. All rights reserved.

Published
2017

2. Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)

Author

Authors/Task Force Members, Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G, ESC Committee for Practice Guidelines, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Document Reviewers, Al Attar N, Andreotti F, Aschermann M, Asteggiano R, Benza R, Berger R, Bonnet D, Delcroix M, Howard L, Kitsiou AN, Lang I, Maggioni A, Nielsen Kudsk JE, Park M, Price S, Domenech MT, Vonk Noordegraaf A, Zamorano J.L., PERRONE FILARDI, PASQUALE, Authors/Task Force, Member, Galiè, N, Hoeper, Mm, Humbert, M, Torbicki, A, Vachiery, Jl, Barbera, Ja, Beghetti, M, Corris, P, Gaine, S, Gibbs, J, Gomez Sanchez, Ma, Jondeau, G, Klepetko, W, Opitz, C, Peacock, A, Rubin, L, Zellweger, M, Simonneau, G, ESC Committee for Practice, Guideline, Vahanian, A, Auricchio, A, Bax, J, Ceconi, C, Dean, V, Filippatos, G, Funck Brentano, C, Hobbs, R, Kearney, P, Mcdonagh, T, Mcgregor, K, Popescu, Ba, Reiner, Z, Sechtem, U, Sirnes, Pa, Tendera, M, Vardas, P, Widimsky, P, Document, Reviewer, Al Attar, N, Andreotti, F, Aschermann, M, Asteggiano, R, Benza, R, Berger, R, Bonnet, D, Delcroix, M, Howard, L, Kitsiou, An, Lang, I, Maggioni, A, Nielsen Kudsk, Je, Park, M, PERRONE FILARDI, Pasquale, Price, S, Domenech, Mt, Vonk Noordegraaf, A, Zamorano, J. L., Cardiovascular Centre (CVC), Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, and Simonneau G.

Subjects
medicine.medical_treatment, Diagnostic Techniques, Cardiovascular, Cardiovascular Agents/therapeutic use, Cardiovascular, Anoxia, Risk Factors, Biological Markers/blood, Hypoxia, Referral and Consultation, Heart Diseases/complications/diagnosis/therapy, media_common, Terminal Care, ddc:618, Exercise Tolerance, Pulmonary, Prognosis, Terminal Care/methods, Thromboembolism/complications/diagnosis/therapy, Hypertension, Cardiology, Cardiology and Cardiovascular Medicine, Algorithms, Lung Transplantation, medicine.medical_specialty, Hypertension, Pulmonary/*diagnosis/etiology/*therapy, Heart Diseases, media_common.quotation_subject, Hypertension, Pulmonary, MEDLINE, Pulmonary Veno-Occlusive Disease/complications/diagnosis/therapy, Internal medicine, Thromboembolism, Exercise Tolerance/physiology, medicine, Lung transplantation, Humans, Quality (business), Task force, business.industry, Conflict of interest, Cardiovascular Agents, Evidence-based medicine, Diagnostic Techniques, Clinical trial, Cardiovascular agent, Anoxia/complications/diagnosis/therapy, Pulmonary Veno-Occlusive Disease, business, Biomarkers
Abstract

Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. Unpublished clinical trial results are not taken into account. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 . View this table: Table 1 Classes of recommendations View this table: Table 2 Levels of evidence The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise …

Published
2009
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3. Guidelines on the identification and treatment of pulmonary hypertension

Author

Galie, Nazzareno, Marius Hoeper, Humbert, Marc, Torbicki, Adam, Vachiery, Jean-Luc, Barbera, Joan Albert, Beghetti, Maurice, Corris, Paul, Gaine, Sean, Gibbs, J. Simon, Gomez-Sanchez, Miguel Angel, Jondeau, Guillaume, Klepetko, Walter, Opitz, Christian, Peacock, Andrew, Rubin, Lewis, Zellweger, Michael, Simonneau, Gerald, Vahanian, Alec, Auricchio, Angelo, Bax, Jeroen, Ceconi, Claudio, Dean, Veronica, Filippatos, Gerasimos, Funck-Brentano, Christian, Hobbs, Richard, Kearney, Peter, Mcdonagh, Theresa, Mcgregor, Keith, Popescu, Bogdan A., Reiner, Zeljko, Sechtem, Udo, Sirnes, Per Anton, Tendera, Michal, Vardas, Panos, Widimsky, Petr, Al Attar, Nawwar, Andreotti, Felicita, Aschermann, Michael, Asteggiano, Riccardo, Benza, Ray, Berger, Rolf, Bonnet, Damien, Delcroix, Marion, Howard, Luke, Kitsiou, Anastasia N., Lang, Irene, Maggioni, Aldo, Nielsen-Kudsk, Jens Erik, Park, Myung, Perrone-Filardi, Pasquale, Price, Suzanna, Domenech, Maria Teresa Subirana, Vonk-Noordegraaf, Anton, Zamorano, Jose Luis, Galie, N1, Hoeper, Mm, Humbert, M, Torbicki, A, Vachiery, Jl, Barbera, Ja, Beghetti, M, Corris, P, Gaine, S, Gibbs, J, Gomez Sanchez, Ma, Jondeau, G, Klepetko, W, Opitz, C, Peacock, A, Rubin, L, Zellweger, M, Simonneau, G, Vahanian, A, Auricchio, A, Bax, J, Ceconi, C, Dean, V, Filippatos, G, Funck Brentano, C, Hobbs, R, Kearney, P, Mcdonagh, T, Mcgregor, K, Popescu, Ba, Reiner, Z, Sechtem, U, Sirnes, Pa, Tendera, M, Vardas, P, Widimsky, P, Al Attar, N, Andreotti, F, Aschermann, M, Asteggiano, R, Benza, R, Berger, R, Bonnet, D, Delcroix, M, Howard, L, Kitsiou, An, Lang, I, Maggioni, A, Nielsen Kudsk, Je, Park, M, PERRONE FILARDI, Pasquale, Price, S, Domenech, Mt, Vonk Noordegraaf, A, and Zamorano, Jl

Published
2009

4. Long-Term Follow-Up After Ablation of Intra-Atrial Re-Entrant Tachycardia in Patients With Congenital Heart Disease: Types and Predictors of Recurrence.

Author

Roca-Luque I, Rivas-Gándara N, Dos Subirà L, Francisco Pascual J, Pijuan-Domenech A, Pérez-Rodon J, Subirana-Domenech MT, Santos-Ortega A, Rosés-Noguer F, Miranda-Barrio B, Ferreira-Gonzalez I, Casaldàliga Ferrer J, García-Dorado García D, and Moya Mitjans A

Subjects
Adult, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prospective Studies, Recurrence, Young Adult, Atrial Flutter epidemiology, Atrial Flutter surgery, Catheter Ablation adverse effects, Catheter Ablation statistics & numerical data, Heart Defects, Congenital complications, Heart Defects, Congenital epidemiology
Abstract

Objectives: The aim of this study was to analyze the long-term outcomes after intra-atrial re-entrant tachycardia (IART) ablation in congenital heart disease (CHD)., Background: IART increases morbidity and mortality in CHD patients. Radiofrequency catheter ablation has evolved into the first-line treatment of this complication., Methods: This was a prospective, single-center study of all consecutive CHD patients who underwent first ablation for IART from January 2009 to December 2015 (n = 94, 39.4% female, age 36.55 ± 14.9 years, follow-up 44.45 ± 22.7 months)., Results: During the study period, 130 procedures were performed (n = 94, 1.21 ± 0.41 IART/patient). In the first procedure, 114 IART were ablated (short-term success 74.66%). Forty-nine percent of the patients whose IART was ablated had non-cavotricuspid isthmus (CTI)-related IART (alone or with concomitant CTI IART). After the first ablation, 54.3% maintained sinus rhythm (SR), 23.9% presented with recurrence of the ablated IART, 14.2% developed new IART, and 7.6% presented with atrial fibrillation (AF). After the second radiofrequency catheter ablation, 78.3% were in SR, 8.7% presented with AF, and 23.0% presented with IART (50% new IART). Multivariate predictors of recurrences were non-CTI IART (hazard ratio [HR]: 5.06; 95% confidence interval [CI]: 1.6 to 15.9; p = 0.006), PR interval >200 ms (HR: 4.02; 95% CI: 1.9 to 11.3; p = 0.009), AF induction (HR: 3.11; 95% CI: 1.1 to 9.1; p = 0.04). and previous AF (HR: 3.08; 95% CI: 1.1 to 9.3; p = 0.04). A risk score according multivariate model identified 3 levels of recurrence risk: 5.8%, 20%, and 58.5% (area under the receiver-operating characteristic curve 0.8 ± 0.03; p < 0.0001)., Conclusions: Ablation of IART in CHD is a challenging procedure, but after ablation in experienced centers, SR can be maintained in 78.3%. Predictors of recurrences are non-CTI-related IART, long PR interval, and previous or induced AF. A risk score based on these factors can be useful for recurrence prediction., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2018
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5. Pulmonary hypertension and congenital heart disease: An insight from the REHAP National Registry.

Author

Alonso-Gonzalez R, Lopez-Guarch CJ, Subirana-Domenech MT, Ruíz JMO, González IO, Cubero JS, Del Cerro MJ, Salvador ML, Subira LD, Gallego P, and Escribano-Subias P

Subjects
Adult, Female, Follow-Up Studies, Heart Defects, Congenital diagnosis, Heart Defects, Congenital epidemiology, Humans, Male, Middle Aged, Spain epidemiology, Young Adult, Eisenmenger Complex diagnosis, Eisenmenger Complex epidemiology, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary epidemiology, Registries
Abstract

Background: Pulmonary arterial hypertension (PAH) is common in patients with congenital heart disease (CHD). Although Eisenmenger syndrome may be on decline, other types of PAH-CHD are increasing and little is known on long-term outcome of this population. We report the PAH-CHD population of Spain via a national registry with focus on long-term survival., Methods and Results: A total of 240 consecutive patients (age 37.7 ± 14.1 years, 67.9% females) with PAH-CHD included in the REHAP registry were analysed. Patients were classified into 3 groups: 1) Eisenmenger syndrome, 2) postoperative-PAH and 3) PAH associated with small defects. Over a median follow-up time of 4.5[1.6-7.1]years, 50 patients (20.8%) died or underwent lung/heart-lung transplantation. Patients with Eisenmenger syndrome had better survival than postoperative-PAH (HR 0.1 95% CI: 0.2-0.9, p=0.048) but no advantage compared to small defects (HR 4.4, 95% CI 0.6-31.4, p=0.15). In the overall PAH-CHD population, patients in NYHA functional class III-IV had a 3-fold increased risk of death (HR 3.0, 95% CI: 1.5-5.9, p=0.001). Amongst patients with Eisenmenger syndrome, a pre-tricuspid shunt had a 2.6-fold increase risk of death (HR 2.6, 95% CI: 1.2-5.6, p=0.03). There was no significant difference in survival between patients with postoperative-PAH and patients with iPAH (HR 0.99 95% CI: 0.6-1.7, p=0.97)., Conclusion: PAH-CHD is associated with mid to long-term mortality. Outcome relates closely to functional class, type of PAH-CHD and within the Eisenmenger cohort, with location of the shunt. Adults with postoperative-PAH have the worse prognosis in the PAH-CHD cohort, reinforcing the need for lifelong close follow-up of such patients., (Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.)

Published
2015
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