Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort
Author:
Calderón-Parra Jorge12ORCID, Domínguez Fernando23, González-Rico Claudia4, Arnaiz de las Revillas Francisco4, Goenaga Miguel Ángel5, Alvarez I5, Muñoz Patricia6, Alonso David6, Rodríguez-García Raquel7, Miró José María8, De Alarcón Arístides9, Antorrena Isabel10, Goikoetxea-Agirre Josune11, Moral-Escudero Encarnación12, Ojeda-Burgos Guillermo13, Ramos-Martínez Antonio1214, , Sánchez Fernando Fernández, de Lomas José Mª García, Rosas Gabriel, de la Torre Lima Javier, Bereciartua Elena, Vidal María José Blanco, Blanco Roberto, Boado María Victoria, Lázaro Marta Campaña, Crespo Alejandro, Carrión Laura Guio, de Lagos Mikel Del Álamo Martínez, Ugarte Gorane Euba, Goikoetxea Ane Josune, Hierro Marta Ibarrola, Iruretagoyena José Ramón, Zuazabal Josu Irurzun, López-Soria Leire, Montejo Miguel, Nieto Javier, Rodrigo David, Rodríguez Regino, Vitoria Yolanda, Voces Roberto, López Mª Victoria García, Georgieva Radka Ivanova, Ojeda Guillermo, Bailón Isabel Rodríguez, Morales Josefa Ruiz, Rodríguez Ignacio Álvarez, Galparsoro Harkaitz Azkune, Boronat Elisa Berritu, Odriozola Mª Jesús Bustinduy, Martín Cristina del Bosque, Echeverría Tomás, Yarza Alberto Eizaguirre, Fuentes Ana, Goenaga Miguel Ángel, del Río Muskilda Goyeneche, Bauza Ángela Granda, Iribarren José Antonio, Urkola Xabier Kortajarena, López José Ignacio Pérez-Moreiras, Jiménez Ainhoa Rengel, Reviejo Karlos, Berbejillo Alberto Sáez, Haza Elou Sánchez, Alda Rosa Sebastián, Ruiz Itziar Solla, Ugartemendia Irati Unamuno, Anza Diego Vicente, Benito Iñaki Villanueva, Arrieta Mar Zabalo, Carrasco Rafael, Climent Vicente, Llamas Patricio, Merino Esperanza, Plazas Joaquín, Reus Sergio, Alonso Alicia, Bouzas Alberto, Castelo Brais, Cuenca José, Gutiérrez Laura, Ramos Lucía, Mayo María Rodríguez, Serrano Joaquín Manuel, Regueiro Dolores Sousa, Martínez Francisco Javier, del Mar Alonso Mª, Castro Beatriz, Melian Teresa Delgado, Sarabia Javier Fernández, Rosado Dácil García, González Julia González, Lacalzada Juan, de la Peña Lissete Lorenzo, Ramírez Alina Pérez, Arrondo Pablo Prada, Moreno Fermín Rodríguez, Ciezar Antonio Plata, Iglesias José Mª Reguera, Álvarez Víctor Asensi, Costas Carlos, de la Hera Jesús, Suárez Jonnathan Fernández, Fraile Lisardo Iglesias, Arguero Víctor León, Menéndez José López, Bajo Pilar Mencia, Morales Carlos, Torrico Alfonso Moreno, Palomo Carmen, Martínez Begoña Paya, Esteban Ángeles Rodríguez, García Raquel Rodríguez, Asensio Mauricio Telenti, Almela Manuel, Ambrosioni Juan, Azqueta Manuel, Brunet Mercè, Bodro Marta, Cartañá Ramón, Cuervo Guillermo, Falces Carlos, Fernández-Pittol Mariana J, Fita Guillermina, Fuster David, de la Mària Cristina García, García-Pares Delia, Hernández-Meneses Marta, Pérez Jaume Llopis, Marco Francesc, Miró José M, Moreno Asunción, Nicolás David, Ninot Salvador, Quintana Eduardo, Paré Carlos, Pereda Daniel, Pericás Juan M, Pomar José L, Ramírez José, Roque Mercè, Rovira Irene, Sandoval Elena, Sitges Marta, Soy Dolors, Téllez Adrián, Tolosana José M, Vidal Bárbara, Vila Jordi, Adán Iván, Alonso David, Alonso Juan Carlos, Álvarez-Uría Ana, Bermejo Javier, Bouza Emilio, Caballero Gregorio Cuerpo, Montero Antonia Delgado, Estévez Agustín, Ribas Ramón Fortuny, Gargallo Esther, Leoni Mª Eugenia García, Mansilla Ana González, Moraga Francisco Javier González, Ramallo Víctor González, Hernández Martha Kestler, Hualde Amaia Mari, Machado Marina, Marín Mercedes, Martínez-Sellés Manuel, Melero Rosa, Muñoz Patricia, Monzón Diego, Olmedo María, Pedraz Álvaro, Pinilla Blanca, Pinto Ángel, Rincón Cristina, Rodríguez-Abella Hugo, Rodríguez-Créixems Marta, Sánchez-Pérez Eduardo, Segado Antonio, Toledo Neera, Valerio Maricela, Vázquez Pilar, Moreno Eduardo Verde, de la Villa Sofía, Antorrena Isabel, Loeches Belén, Moreno Mar, Ramírez Ulises, Bastón Verónica Rial, Romero María, Rosillo Sandra, Balbín Jesús Agüero, Fernández Cristina Amado, Castillo Carlos Armiñanzas, de las Revillas Francisco Arnaiz, Belaustegui Manuel Cobo, Fariñas María Carmen, Fariñas-Álvarez Concepción, Sampedro Marta Fernández, García Iván, Rico Claudia González, Gutiérrez-Fernández Laura, Gutiérrez-Cuadra Manuel, Díez José Gutiérrez, Pajarón Marcos, Parra José Antonio, Teira Ramón, Zarauza Jesús, Parra Jorge Calderón, Cobo Marta, Domínguez Fernando, Pavía Pablo García, Cruz Ana Fernández, Ramos-Martínez Antonio, Romero Isabel Sánchez, Centella Tomasa, Hermida José Manuel, Moya José Luis, Martín-Dávila Pilar, Navas Enrique, Oliva Enrique, del Río Alejandro, Stuart Jorge Rodríguez-Roda, Ruiz Soledad, Tenorio Carmen Hidalgo, Sequera Sergio, Delia Manuel Almendro, Araji Omar, Barquero José Miguel, Jambrina Román Calvo, de Cueto Marina, Acebal Juan Gálvez, Méndez Irene, Morales Isabel, López-Cortés Luis Eduardo, de Alarcón Arístides, Gutiérrez-Carretero Encarnación, Lepe José Antonio, López-Haldón José, Luque-Márquez Rafael, Marín Guillermo, Ortiz-Carrellán Antonio, Sánchez-Domínguez Eladio, Alonso Luis Javier, Azcárate Pedro, Gutiérrez José Manuel Azcona, Blanco José Ramón, Armas Estíbaliz Corral, García-Álvarez Lara, Oteo José Antonio, Membrilla Antonio Barros, Iglesias Antonino Ginel, Grillo Sara, Petracca Rubén Leta, López-Contreras Joaquín, Martínez María Alba Rivera, Álvarez M, Fernández A L, Martínez Amparo, Prieto A, Regueiro Benito, Tijeira E, Vega Marino, Quiñonero Amaia Aguirre, Miñambres Ángela Alonso, Arana Juan Carlos Gainzarain, de Alaiza Ortega Sara González, Rodríguez Miguel Ángel Morán, Rodríguez Anai Moreno, de Zárate Zuriñe Ortiz, Zapirain José Joaquín Portu, de Adana Arroniz Ester Sáez, Sánchez Daisy Carolina Sorto, Antonio Sánchez-Porto, Alejandro Úbeda Iglesias, Leal José Mª Arribas, Vázquez Elisa García, Torres Alicia Hernández, Blázquez Ana, de la Morena Valenzuela Gonzalo, Alonso Ángel, Aramburu Javier, Calvo Felicitas Elena, Rodríguez Anai Moreno, Tarabini-Castellani Paola, Gálvez Eva Heredero, Bellido Carolina Maicas, Pau José Largo, Sepúlveda Mª Antonia, Sierra Pilar Toledano, Iqbal-Mirza Sadaf Zafar, Alcolea Eva Cascales, Yañez Ivan Keituqwa, Martínez Julián Navarro, Ballesta Ana Peláez, Escobar Eduardo Moreno, Monje Alejandro Peña, Cabrera Valme Sánchez, García David Vinuesa, Asenjo María Arrizabalaga, Luna Carmen Cifuentes, Morcillo Juana Núñez, Seco Mª Cruz Pérez, Gelabert Aroa Villoslada, Guallar Carmen Aured, Abad Nuria Fernández, Mangas Pilar García, Adell Marta Matamala, Ruiz Mª Pilar Palacián, Porres Juan Carlos, Vidal Begoña Alcaraz, Del Amor Espín María Jesús, Buendía Francisco, Sánchez Roberto Jiménez, Mármol Rosario, Martínez Francisco, Meseguer Antonio, Pérez Beatriz, Risco Leticia, Saura Zoser, Silva Vanina, Villmarín Mª Belén, Blanco Mª Ángels Ribas, de Gopegui Bordes Enrique Ruiz, Bonet Laura Vidal, Borràs Miquel Vives, Munera Mª Carmen Bellón, Garaizabal Elena Escribano, Martínez Antonia Tercero, Luque Juan Carlos Segura, Badía Cristina, Palop Lucía Boix, Xercavins Mariona, Bosch Sónia Ibars. Xerach, Nebreda Eloy Gómez, Herrera Ibalia Horcajada, Gallego Irene Menduiña, Pulido Imanol, Santiago Héctor Marrero, de Miguel Martínez Isabel, Álamo Elena Pisos, Sánchez Daniel San Román, Pérez Jorge Boan, Blanco Eva Mª Aguilar, González Mercedes Catalán, Peiretti María Angélica Corres, Esteve Andrea Eixerés, Pérez Laura Domínguez, de Cossío Tejido Santiago, Román Francisco Galván, Robles José Antonio García, Medrano Francisco López, Gude Mª Jesús López, Miguel Mª Ángeles Orellana, Pilkington Patrick, Ostalaza Yolanda Revilla, Morales Juan Ruiz, Solís Sebastián Ruiz, Collado Ana Sabín, Fernández Marcos Sánchez, Rallo Javier Solera, Escrihuela-Vidal Jorge Solís Martín. Francesc, Carratalà Jordi, Grau Inmaculada, Ardanuy Carmen, Berbel Dámaris, Salado José Carlos Sánchez, Alegre Oriol, Majoral Alejandro Ruiz, Sbraga Fabrizio, Blasco Arnau, Sánchez Laura Gracia, Aldamiz Iván Sánchez-Rodríguez. Gonzalo, Álvarez Beatriz, Palacios Marina Bernal, Úbeda Alfonso Cabello, Roblas Ricardo Fernández, Hernández Rafael, Martín Victoria Andrea Hortigüela, Kallmeyer Andrea, Kancev Cristina Landaeta, Martín Marta, Ruiz Miguel Morante, Lobato Miguel Ángel Navas, Pello Ana María, Prieto Laura, Mallebrera Marta Tomás, de la Peña Triguero Laura Varela Mireia, Cerón Ruth Esther Figueroa, Ble Lara Ruiz Gómez. Mireia, Gallego Juan Pablo Horcajada, Ginel Antonio José, López Inmaculada, Mas Alexandra, Mestres Antoni, Molina Lluís, Serrat Ramón, Ribas Núria, Sánchez Francisca, Silverio Ana, Suárez Marina, Sorlí Luisa, Recasens Lluís, Regueras Manuel Taurón. María Fernández, Vallejo María Ángeles Mantecón, Rivera José Ángel Pérez, Cano Nuria Sánchez Mata. Antonia Calvo, Olivares Miguel Fajardo, Núñez María Victoria Millán, Sanz Agustín Muñoz
Affiliation:
1. Infectious Diseases Unit, Department of Internal Medicine, Puerta de Hierro University Hospital , Majadahonda , Spain 2. Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA) , Majadahonda , Spain 3. Department of Cardiology, Puerta de Hierro University Hospital , Majadahonda , Spain 4. Department of Infectious Diseases, University Hospital Marqués de Valdecilla, CIBER Infectious Diseases (CIBERINFEC, CB21/13/00068). Cantabria University , Santander , Spain 5. Department of Infectious Diseases, OSI Donostialdea , San Sebastian , Spain 6. Department of Microbiology and Infectious Diseases, University Hospital Gregorio Marañón, CIBER Respiratory Diseases (CIBERES, CB06/06/0058), Complutense University , Madrid , Spain 7. Intensive Care Department, University Hospital of Asturias , Oviedo , Spain 8. Department of Infectious Diseases, Clinic Hospital—IDIBAPS, University of Barcelona , Barcelona , Spain 9. Infectious Diseases, Microbiology, and Parasitology Unit, University Hospital Virgen del Rocio, Seville University , Seville , Spain 10. Cardiology Department, University Hospital La Paz- IDIPAZ , Madrid , Spain 11. Infectious Diseases Department, University Hospital Cruces , Bilbao , Spain 12. Internal Medicine Department, University Hospital Virgen de la Arrixaca , Murcia , Spain 13. Infectious Diseases Unit, University Hospital Virgen de la Victoria , Malaga , Spain 14. Faculty of Medicine, Autónoma University of Madrid , Madrid , Spain
Abstract
Abstract
Background
Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied.
Objectives
To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA.
Methods
Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020.
Results
Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49–3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1–7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045).
Conclusions
MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes.
Publisher
Oxford University Press (OUP)
Reference42 articles.
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