In the intravenous drug user (IVDU) population, infected right-sided valvular lesions are common, and this has been well described in the literature. The Eustachian valve (also known as the valve of the inferior vena cava) is another valve in close proximity to the tricuspid valve, which can, in rare cases, be the focus of infection. Eustachian valve endocarditis may be an under-recognised complication of Staphylococcus bacteraemia in IVDU population, often only identified by transesophageal imaging. We present a case of tricuspid valve endocarditis in an IVDU with secondary seeding on the Eustachian valve, and an accompanying literature review on this rare topic.
srecognised as an important predictor of short-term adverse outcomes in this population. We sought whether cognitive function in HF is associated with atrial or ventricular dysfunction.Methods: 731 HF pts (61% male, median age 75 years, and 55% with EF < 40%) were recruited in five states of Australia (New South Wales, Queensland, South Australia, Tasmania and Victoria). Cardiac function was assessed by 2D echocardiography. Cognitive function (including seven cognitive domains) was assessed using the Montreal Cognitive Assessment (MoCA). Clinical, socio-demographic and blood biochemical factors were also collected.Results: Among 731 HF patients, 28% had mild cognitive impairment (MoCA score 17-23) and 16% had dementia (MoCA score < 17). Echo parameters of diastolic function, but not systolic function, were correlated with worse MoCA score. Among these parameters, left atrial volume index (LAVi) was the strongest predictor (r = −0.23 p < 0.001) of cognitive function, and was most strongly associated with memory (r = −0.21 p < 0.001) and orientation (r = − 0.23 p < 0.001). This association was independent of age, sex, Charlson comorbidity index, HF classification, brain natriuretic peptide and socio-demographic factors. Stratified analysis showed a stronger association of LAVi with cognitive function among patients without atrial fibrillation (r = −0.27 p < 0.001) than those with atrial fibrillation (r = −0.16 p = 0.009).Conclusions: Worse diastolic function is associated with worse cognitive function among HF patients, with LAVi as the strongest predictor. The role of occult atrial fibrillation warrants further clarification among those in sinus rhythm. http://dx.
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