Background-Because of the increased use of pacemakers and implantable cardioverter defibrillators, infection has become a complication with significant morbidity and mortality. Data on risk factors for mortality in patients with cardiac-device related infection are limited. We evaluated the prognostic significance of key clinical and echocardiographic variables in a large retrospective population of patients with cardiac-device related infection. Methods and Results-Two hundred ten patients with cardiac-device related infection were identified at the University of Michigan between 1995 and 2006. Data were abstracted on key clinical and echocardiographic variables, treatment strategy, and 6-month outcomes. We used multivariable Cox proportional hazards models to examine clinical and echocardiographic variables that were associated with 6-month mortality. Mean age for our study population was 63Ϯ17 years, and 72 (44%) were women. All-cause 6-month mortality was 18% (nϭ37). Independent variables associated with death were systemic embolization (hazard ratio 7.11; 95% CI 2.74 to 18.48), moderate or severe tricuspid regurgitation (hazard ratio 4.24; 95% CI 1.84 to 9.75), abnormal right ventricular function (hazard ratio 3.59; 95% CI 1.57 to 8.24), and abnormal renal function (hazard ratio 2.98; 95% CI 1.17 to 7.59). Size and mobility of cardiac device vegetations were not independently associated with mortality. Conclusions-We identified several clinical and echocardiographic variables that identify patients with cardiac-device related infection who are at high-risk for mortality and may benefit from more aggressive evaluation. (Circ Arrhythmia Electrophysiol. 2009;2:129-134.)

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Augmented cardiac sympathetic tone and responsiveness and impaired myocardial perfusion may contribute to myocardial injury in diabetes.

A hand-carried personal ultrasound device (HCPUD) may be used for rapid cardiac screening by physicians with limited echo training. Our objective was to determine the accuracy of rapid HCPUD evaluation of left ventricular (LV) size and function when used by a Cardiology Fellow. Forty-five patients underwent an HCPUD exam using a 2.4-kg device with a 2- to 4-MHz curved transducer and color power Doppler (SonoSite). The results were compared with sonographer-performed and echocardiographer-interpreted exams using conventional equipment. The HCPUD exam lasted 6 +/- 2 minutes. There was 100% agreement between HCPUD and conventional echo on qualitative assessment of LV systolic function. Comparing the HCPUD and conventional linear measurements of left ventricular end-diastolic dimension (LVEDD) and of interventricular septal (IVS) thickness: LVEDD is HCPUD = 0.94 conventional -0.2,r = 0.82, P < 0.0001; IVS is HCPUD= 0.59 conventional+0.6, r = 0.69, P < 0.0001. Thus, an HCPUD can effectively be used after limited training to rapidly screen for qualitative abnormalities of LV systolic function. Quantitative measurements of smaller structures with the HCPUD are more challenging.

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