心脏装置移除后与装置相关感染性心内膜炎的诊断。
Diagnosis of cardiac device-related infective endocarditis after device removal.
机构信息
Department of Cardiology, La Timone Hospital, Marseille, France.
出版信息
JACC Cardiovasc Imaging. 2010 Jul;3(7):673-81. doi: 10.1016/j.jcmg.2009.12.016.
OBJECTIVES
We sought to determine the incidence, diagnostic value, and outcome of intracardiac masses observed by echocardiography after device removal. We hypothesized that these "ghosts" of leads could be associated with the diagnosis of cardiac device-related infective endocarditis (CDRIE).
BACKGROUND
The echocardiographic appearance of residual floating masses in the right atrium after removal of permanent pacemakers and implantable cardioverter-defibrillators was recently described. However, the significance of these ghosts and their relationship with CDRIE are unknown.
METHODS
The pre-operative clinical, microbiological, and echocardiographic conditions; the indication; and the removal technique were analyzed in a retrospective cohort including all consecutive patients who underwent percutaneous lead removal. Three groups were formed according to the final diagnosis: CDRIE, local device infection, and noninfectious indications. The incidence of ghosts was compared among the 3 groups. All clinical, infectious, and extraction-related factors were studied for their association with ghosts. All patients with ghosts were followed after hospitalization.
RESULTS
Two hundred twelve patients underwent lead removal. Ghosts were observed in 17 patients (8% incidence), including 14 (16%) of 88 patients with CDRIE and 3 (5%) of 59 patients with local device infection. Ghosts were never observed among the remaining 65 noninfected patients. A significant association was found between CDRIE and the presence of a ghost (odds ratio: 7.63, 95% confidence interval: 2.12 to 27.45, p = 0.001). At 3 months, 2 patients with ghosts died suddenly, 2 underwent surgery, and 1 had a pulmonary embolism.
CONCLUSIONS
Ghosts are observed in 8% of patients after percutaneous device extraction. Their presence is suggestive of device infection and seems to be associated with the diagnosis of CDRIE. The prognostic significance of such findings needs further investigation.
目的
我们旨在确定心脏内肿块的发生率、诊断价值和预后，这些肿块是通过移除设备后超声心动图观察到的。我们假设这些“幽灵”导联可能与心脏器械相关感染性心内膜炎（CDRIE）的诊断有关。
背景
最近描述了在移除永久性起搏器和植入式除颤器后右心房残留漂浮肿块的超声心动图表现。然而，这些“幽灵”的意义及其与 CDRIE 的关系尚不清楚。
方法
我们对所有接受经皮导线移除的连续患者进行回顾性队列研究，分析了术前临床、微生物学和超声心动图条件、适应证和移除技术。根据最终诊断将患者分为三组：CDRIE、局部设备感染和非感染性适应证。比较三组之间“幽灵”的发生率。研究了所有与临床、感染和提取相关的因素与“幽灵”的关系。所有有“幽灵”的患者在住院后都进行了随访。
结果
212 例患者接受了导线移除。17 例（8%的发生率）患者观察到“幽灵”，其中 88 例 CDRIE 患者中有 14 例（16%），59 例局部设备感染患者中有 3 例（5%）。在其余 65 例非感染患者中从未观察到“幽灵”。CDRIE 与“幽灵”的存在之间存在显著关联（优势比：7.63，95%置信区间：2.12 至 27.45，p = 0.001）。在 3 个月时，2 例有“幽灵”的患者突然死亡，2 例患者接受了手术，1 例患者发生了肺栓塞。
结论
经皮器械取出后，8%的患者观察到“幽灵”。它们的存在提示设备感染，似乎与 CDRIE 的诊断有关。这些发现的预后意义需要进一步研究。
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