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The impact of transoesophageal echocardiography in elderly patients with infective endocarditis - 25/05/23

Doi : 10.1016/j.acvd.2023.04.001 
Marie-Paule B. N’cho-Mottoh a, Marie-Line Erpelding b, Claire Roubaud c, François Delahaye d, Thibaut Fraisse e, Marina Dijos c, Pierre-Vladimir Ennezat f, Arnaud Fluttaz g, Benjamin Richard h, Corinne Beaufort i, Pierre Nazeyrollas j, Camille Brasselet k, Olivier Pineau l, Pierre Tattevin m, Elodie Curlier n, Bernard Iung o, Emmanuel Forestier g, Christine Selton-Suty a,
a University Hospital of Nancy-Brabois, 54511 Vandoeuvre Les Nancy, France 
b CHRU of Nancy, Inserm, université de Lorraine, CIC, épidémiologie clinique, 54000 Nancy, France 
c University Hospital of Bordeaux, 33000 Bordeaux, France 
d Hospital Louis Pradel, 69500 Bron, France 
e Alès Hospital, 30100 Alès, France 
f University Hospital of Grenoble, 38700 La Tronche, France 
g Chambéry Hospital, 73000 Chambéry, France 
h Annecy Hospital, 74370 Epagny Metz-Tessy, France 
i University Hospital of Poitiers, 86000 Poitiers, France 
j University Hospital of Reims, 51100 Reims, France 
k Clinique Courlancy, 51100 Reims, France 
l Villeneuve St Georges Hospital, 91560 Crosne, France 
m University Hospital of Rennes, 35000 Rennes, France 
n University Hospital of Guadeloupe, Les Abymes 97142, France 
o Bichat-Claude Bernard Hospital, 75018 Paris, France 

Corresponding author. Cardiology Department, CHU of Nancy-Brabois, 54511 Vandoeuvre les Nancy, France.Cardiology Department, CHU of Nancy-BraboisVandoeuvre les Nancy54511France

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Graphical abstract




Le texte complet de cet article est disponible en PDF.

Highlights

We compared patients aged > 75 years treated for IE, who did/did not undergo TEE.
Patients without TEE were older, with more comorbidities.
Patients without TEE had poorer functional, nutritional and cognitive statuses.
Patients without TEE underwent surgery for a recognized indication less often.
Patients without TEE had a poorer prognosis.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions.

Aim

To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality.

Methods

A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75–101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE.

Results

Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE.

Conclusions

Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.

Le texte complet de cet article est disponible en PDF.

Keywords : Infective endocarditis, Transoesophageal echocardiography, Elderly, Geriatric assessment


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 Tweet: Old patients who did not undergo TEE during the treatment of IE had poorer functional, nutritional and cognitive statuses, had less often previously known valvular disease, less often perivalvular abscess, were less often operated on and had a poorer prognosis than patients who had TEE.


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P. 258-264 - mai 2023 Retour au numéro
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