Paul Pappas

Duke Medical Center

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Trends

Author Order

Document Type

Co-Authors

Vance G. Fowler

Duke Medical Center

Bruno Hoen

Institut thématique Santé Publique

Christopher H. Cabell

Arena Pharmaceuticals (United States)

José M. Miró

Universitat de Barcelona

Vivian H. Chu

Duke University

Andrew Wang

Duke University

Lars Olaison

University of Gothenburg

Daniel J. Sexton

Duke Medical Center

Bruno Baršić

University of Zagreb

Christine Selton‐Suty

Centre Hospitalier Régional et Universitaire de Nancy

Cooperative Institutions

Duke Medical Center

Duke University

Duke University Hospital

Clinical Research Institute

Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

Universitat de Barcelona

Hospital Clínic de Barcelona

Inserm

Instituto de Salud Carlos III

The University of Texas Southwestern Medical Center

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study

American Heart Journal (2007)

Lawrence Liao Kevin J. Anstrom John S. Gottdiener Paul Pappas David J. Whellan

Cardiovascular Health

10.1016/j.ahj.2006.11.010

Cite

Citations (96)

Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke

Bruno Baršić Н. С. Чипигина Stuart A. Dickerman Vicenç Falcó Igor Klinar

Infective Endocarditis

Stroke

Source

Cite

Citations (0)

The use and effect of surgical therapy for prosthetic valve infective endocarditis: A propensity analysis of a multicenter, international cohort

American Heart Journal (2005)

Andrew Wang Paul Pappas Kevin J. Anstrom Elías Abrutyn Vance G. Fowler

Infective Endocarditis

10.1016/j.ahj.2005.01.023

Cite

Citations (155)

The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: An analysis from the ICE Prospective Cohort Study (ICE-PCS)

American Heart Journal (2007)

Stuart A. Dickerman Elías Abrutyn Bruno Baršić Emilio Bouza Enrico Cecchi

Infective Endocarditis

Stroke

10.1016/j.ahj.2007.07.023

Cite

Citations (354)

HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort

PLoS ONE (2013)

Stephen T. Chambers David Murdoch Arthur Morris Thomas L Holland Paul Pappas

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34–9.65; p<0.01) and younger age (OR 0.62; CI 0.49–0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

Eikenella corrodens

Infective Endocarditis

Stroke

Haemophilus parainfluenzae

10.1371/journal.pone.0063181

Cite

Citations (223)

Current Features of Infective Endocarditis in Elderly Patients

Archives of Internal Medicine (2008)

Emanuele Durante‐Mangoni Suzanne Bradley Christine Selton‐Suty Marie Françoise Tripodi Bruno Baršić

Background

Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking.

Methods

In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed.

Results

Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism wasStaphylococcus aureus, with a higher rate of methicillin resistance.Streptococcus bovisand enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%;P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%;P < .001), and age older than 65 years was an independent predictor of mortality.

Conclusions

In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care–associated acquisition and improve outcomes in this major subgroup of patients with IE.

Infective Endocarditis

10.1001/archinte.168.19.2095

Cite

Citations (280)

Reply to Shah

Clinical Infectious Diseases (2005)

Vivian H. Chu C. H. Cabell G. R. Corey José M. Miró Martín E. Stryjewski

10.1086/430182

Cite

Citations (2)

Safety and effectiveness of transdermal nicotine patch in smokers admitted with acute coronary syndromes

The American Journal of Cardiology (2005)

Trip J. Meine Manesh R. Patel Jeffrey B. Washam Paul Pappas James G. Jollis

Transdermal patch

10.1016/j.amjcard.2004.12.039

Cite

Citations (104)

Association between type of valve prosthesis and one year mortality in IE: an analysis of 1467 patients from the International collaboration on endocarditis prospective cohort study

European Heart Journal (2013)

François Delahaye Vivian H. Chu Bruno Hoen Carlos A. Mestres Paul Pappas

Purpose: Infective Endocarditis (IE) is a disease which continues to have high mortality and morbidity, including nearly half of patients requiring cardiac surgery during the acute phase of IE. There has been no large, multicenter, prospective series comparing mechanical and biological prostheses in IE. Our objectives were to describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and to examine whether the type of prosthesis was independently associated with in-hospital and 1-year mortality. Methods: The International Collaboration on Endocarditis - Prospective Cohort Study is a prospective, multicenter, international registry of IE cases. Among 5,591 patients 18 years or older, 1,467 patients with definite IE were operated on during the active phase of disease and had a biological (550; 37%) or mechanical (917; 63%) valve replacement. Results: As compared to patients who received mechanical prostheses, those who received bioprostheses were older (62 vs 54 years; p<.0001), more often had a history of cancer (9% vs 6%; p=0.009), and had moderate or severe renal disease (9% vs 4%; p=0.0003). Proportion of health care-associated IE was higher in the bioprosthesis group (26% vs 17%; p<.0001). Intracardiac abscesses were more frequent in the bioprosthesis group (30% vs 23%; p=0.0044). Both in-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively. Only 3 variables were independently associated with the type of prosthesis implanted. Mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10 years; 0.56 - 0.73), and in patients with a history of cancer (0.72; 0.53 - 0.98), but were more commonly implanted in mitral position (1.60; 1.29 - 2.00). In the multivariable analysis, bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298; 1.011-1.665; p=0.041). In sub-group analysis, biologic valve replacement remained independently associated with 1 year mortality in patients less than 65 years old, but not in older patients. Conclusion: Patients with IE who receive a biologic valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biologic valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is likely related to patient characteristics rather than valve dysfunction.

Infective Endocarditis

10.1093/eurheartj/eht310.p4768

Cite

Citations (1)

Influence of cardiac surgery on the outcome of patients with infective endocarditis complicated with hemorrhagic stroke

Bruno Baršić Efthymia Giannitsioti Adina Ionac Igor Klinar Vladimir Krajinović

Infective Endocarditis

Stroke

Source

Cite

Citations (0)