Maladies cardiovasculaires et diagnostic

Aerococcus urinae is a Gram-positive, catalase-negative coccus that was first defined in 1992. A. urinae is responsible for up to 0.8% of all cases of urinary tract infection. Typical predisposing factors include male sex, age >65 years and pre-existing urinary pathology. A. urinae is a rare cause of endocarditis but has a high associated morbidity and mortality. Sepsis or septic shock is the primary clinical presentation but there have been several reports of cerebral ischemic events in the setting of A. urinae endocarditis. These case descriptions are very limited and do not include brain imaging. We describe the clinical course of a 75 year-old man who, in the setting of A. urinae mitral valve endocarditis, presented with symptoms and imaging findings consistent with embolic cerebral infarction. Importantly, mitral valve vegetation was detected only after transesophageal echocardiography. Given the risk of morbidity without treatment, these data support pursuing a transesophageal approach even when transthoracic echo is negative.

1.1 Background: The preventive task force reaffirmed its 2007 recommendation against screening for asymptomatic carotid stenosis with Doppler ultrasound (US). This recommendation was not tailored to include high risk subgroups (diabetics with coronary artery disease).

1.2 Methods: We conducted a retrospective case control study on previously asymptomatic, elderly, diabetic patients with history of coronary artery disease, who presented to our facilities between 2003 and 2009.Participants who had an US preformed were compared to controls who never had an US performed before . After five year period, we recorded outcomes of stroke, mortality and carotid endarterectomy.

1.3 Results: 316 patients were included (192 in study group, 124 controls). No difference in baseline characteristics was reported.18% of the study patients had 60 % stenosis or more. The cumulative stroke incidence was similar between both groups (4.6 % vs 2.4 %), p>0.3. Two carotid artery endarterectomies were performed in the screened group. After adjusting for propensity scores, there was no association between stroke occurrence and ultrasound screening. The odds ratio for development of stroke was 2 (95 % CI, 0.2-7, p=0.2) in unscreened group compared to screened group.

1.4 Conclusion: High atherosclerotic burden in this subgroup might lead clinicians to consider carotid US as a screening tool for stroke prevention. This study is the first to suggest that US does not prevent strokes in high risk subgroups. Large randomized studies are needed to confirm these results.