Canarie

Positron emission tomography and computed tomography (PET/CT) is a very sensitive tool for the diagnosis of infective endocarditis (IE), especially in patients with valve prostheses. Despite its high level of recommendation in the latest clinical practice guidelines, its application and usefulness in real life is still poorly studied. Our objective was to review the profile of patients prescribed PET/CT, as well as its impact on their management in a hospital with cardiovascular surgery that requires transfer of patients to another center for its performance. Observational, retrospective, single-center, retrospective study in which we selected patients admitted between 2016-2023 with suspected or diagnosed IE and collected clinical, echocardiographic, and PET/CT data. From 188 patients, PET/CT was performed in only 14 patients (7.44%), with a median age of 67 years (RIQ 25), 71.4% being male. Infectious involvement was mostly on prosthetic valves (9; 64.3%), mainly late (6; 42.9%), with 3 biological, 5 mechanical and 1 TAVI, in addition to 2 device infections. The indication in native valves was for bicuspid aortic valve and suspected periannular complications. The indications for PET/CT included: diagnostic confirmation by inconclusive transesophageal echocardiography (TEE) in 6 patients (42.9%), extension of the TEE study to verify infectious activity in periannular complications in 4 patients (28.6%) and diagnosis of IE in devices in 4 patients (28.6%), without having been indicated in any patient to assess emboligenic lesions. The median number of days of antibiotic therapy until PET/CT was 14.5 days (RIQ 52). All but one of the PET/CT scans were positive for infective endocarditis, with a median SUVmax of 4.6. As a result of the PET/CT results, the therapeutic approach was modified in 5 patients (35.7%), with valve replacement surgery indicated in 4 patients and one electrode removal. The antibiotherapy regimen was not modified in the remaining patients. Despite its high sensitivity for the diagnosis of IE and its high level of recommendation, PET/CT is underused in our setting, partly due to its low availability. New studies are needed to better define the profile of patients who really benefit from this technique because it implies a change in their clinical management.Indications and therapeutic approach

Aportei score is a validated scale for predicting postoperative mortality in patients with infective endocarditis (IE). This score is mainly used to avoid futility in patients who would not benefit from surgery due to their high risk. Our objective was to compare the occurrence of clinical complications (atrioventricular block (AVB), embolism, stroke) not included as items in the score between the different risk groups; in addition we compare the performance of cardiac surgery in each group. We registered mortality during hospitalization and CV mortality during follow-up. For this purpose, a single-center prospective observational study was conducted in a tertiary hospital. We included patients admitted with a diagnosis of IE between 2016 and 2023 in a tertiary hospital, dividing them according to the Aportei score into low, medium, high and very high risk to compare the incidence of complications among them. From 188 patients with a definitive diagnosis of infective endocarditis (men 72.5%; median age 69 years (RIQ 68)), they were distributed as follows: 27 at low risk, 28 at moderate risk, 53 at high risk and 80 at extreme risk. Surgery was performed in 48.4% of the total; when comparing the performance of surgery between risk groups, no statistically significant differences were found. Regarding stroke complications, a higher percentage was found in patients at high (37%) and very high risk (50%) (p=0.04), although no systemic embolism was found (p=0.5). Patients at higher Aportei risk had a statistically significant higher percentage of AVB (p=0.002). Mortality, regardless of whether surgery was performed, was higher in the groups of patients with higher scores, both cardiovascular (low risk 7.4% vs high risk 20.8%, p<0.001) and overall mortality during admission (low risk 7.2% vs high risk 15.1%, p<0.001). Aportei score, in addition to being a good predictor of mortality in both interventional and non-interventional patients, seems to be related to the appearance of complications such as atrioventricular block and stroke. In our hospital, the indication for surgery was not guided by the Aportei score, with no differences in intervention between the different risk groups.Clinical complicationsAPORTEI risk

Out-of-Hospital Cardiac Arrest (OHCA) causes over 3 million deaths worldwide every year. In Europe, 58% of OHCAs receive bystander CPR. Early and effective CPR improves prognosis. In the Canary Islands, the project "Only hands can save lives" was created, it seeks to increase awareness and social participation in OHCA, promoting CPR training in schools. Hypothesis and objectives: To evaluate the impact of the CPR training through the project "Only hands can save lives" on the students of the Canary Islands after nine months that it has been received. A descriptive cross-sectional study carried out by the students who participate in the project through an anonymous questionnaire. A quantitative and qualitative evaluation were done, and the results were compared with a historical cohort. An analysis was performed based on gender, age and previous participation in the project. A total of 2.577 surveys were obtained. Nine months after basic CPR training, there were significant improvements in various variables: 612 students (23,7%) correctly recognize a cardiac arrest, and 2,337 (90,7%) know the emergency number 112, with girls outperforming boys in this identification (girls: 1.239, 92,9% vs boys: 1.100, 88,5%; p<0.001). Furthermore, age significantly influences the acquisition of knowledge. Previous participation in the project improves knowledge of the nearest AED location (508, 34,1% vs 216, 19,9%; p=0.001). Canary Islands students retain the basic CPR knowledge nine months after training. So, it is essential to maintain these educational programs, one per year, to consolidate knowledge and skills, improve the rate of bystander CPR on OHCA and increase the survival rate.

Understanding the predisposing factors for infective endocarditis (IE) is essential for implementing prevention strategies, prophylaxis, and providing recommendations related to hygiene and other habits. The objective of our study was to investigate possible predisposing factors for IE and compare them with the microbiological findings obtained. A registry of patients diagnosed with IE between 2016 and 2022 at a reference hospital for cardiovascular surgery was utilized. These patients were grouped according to the type of microbiological isolation. These groups were analyzed based on their baseline characteristics, cardiac and extracardiac predisposing factors. Lastly, risk factors present or occurring in proximity to the IE event (endoscopic procedures, dental work, venous infections, etc.) were considered. A total of 189 patients were included, with Enterococcus being the microorganisms most frequently isolated (N=36), followed by S. epidermidis (N=33) and S. aureus (N=35). The median age was 69 years, with differences among groups, showing that patients with infections by Enterococcus, S. aureus, S. epidermidis, and S. bovis presented with IE at an older age (p<0.01). It was found that 61% of patients with IE had some type of pre-existing heart disease, with the presence of valvular heart disease (at least moderate) being the most common (42%). Among these, there was a high frequency of patients with bicuspid valve disease (7%, representing 20% of IE cases in the aortic position), and these patients had a younger age (mean 52 years). The precursor risk factors are described in the image. The Enterococcus family was the most frequently isolated in this study, being associated with recent diagnoses of urothelial tumors and urinary tract instrumental procedures. S. bovis was related to procedures in the gastrointestinal tract and digestive tumors. S. aureus was associated with episodes of phlebitis, and S. viridans with dental procedures, although without reaching significance. The most common predisposing heart disease was valvular heart disease. Bicuspid valve disease was frequent and was associated with infections in younger patients and with microorganisms typical of oral, skin, and urinary tract flora (S. epidermidis, Enterococcus, and S. viridans).Image 1Image 2

The diagnostic delay of infective endocarditis (IE) is common due to its low clinical suspicion and often insidious course. An early diagnosis is essential for prompt treatment initiation and for preventing adverse outcomes. This study aims to analyze the time from the onset of symptoms to a confirmed diagnosis via echocardiography, considering the APORTEI score and microbiological identification, as well as implications for complications and mortality. This was a retrospective observational study conducted on patients diagnosed with IE between 2016 and 2023. The comparison of the mean duration from symptom onset to diagnosis across different groups was performed using Student's t-test (for 2 groups) and ANOVA (for >2 groups). Post-hoc analyses were conducted when statistically significant differences were identified. Among a total of 188 patients (72.5% male; median age: 69 years, interquartile range [IQR]: 68), the median duration from the first symptom to diagnosis was 17 days (IQR: 4–92). Significant new-onset valvular dysfunction (including stenosis, insufficiency, or mixed lesions) was diagnosed in 65.6% of patients; however, no statistically significant differences were observed between the groups. Regarding the incidence of cerebral embolisms, systemic embolisms, and septic shock, there were no statistically significant differences. Differences in the time to diagnosis were observed between infections caused by different microorganisms (F[2,28] = 6, p = 0.04), particularly between S. bovis and S. aureus (p = 0.014), with earlier diagnosis noted in cases involving S. aureus. Significant differences were also found when stratifying by APORTEI risk score (low, moderate, high, and very high risk) (F[3,14] = 3, p = 0.027), with significance between low risk compared to high and very high risk (p = 0.03 and p = 0.027, respectively). Over a follow-up period of 28.4 months, 33.3% of patients died due to cardiovascular causes. These patients were diagnosed earlier, with a mean time to diagnosis of 15.2 days, whereas those who survived experienced a delay in the diagnosis, with a mean of 30.9 days (p = 0.02). Patients with a poorer prognosis were those diagnosed earlier, probably due to a more aggressive disease course, which also coincided with more virulent microorganisms (E. coli, S. aureus) and higher risk stratifications according to the APORTEI score.Mean days and microorganismsMortality and mean days