In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.

Background-Ejection intraventricular pressure gradients are caused by the systolic force developed by the left ventricle (LV). By postprocessing color Doppler M-mode (CDMM) images, we can measure noninvasively the ejection intraventricular pressure difference (EIVPD) between the LV apex and the outflow tract. This study was designed to assess the value of Doppler-derived EIVPDs as noninvasive indices of systolic chamber function. Methods and Results-CDMM images and pressure-volume (conductance) signals were simultaneously acquired in 9 minipigs undergoing pharmacological interventions and acute ischemia. Inertial, convective, and total EIVPD curves were calculated from CDMM recordings. Peak EIVPD closely correlated with indices of systolic function based on the pressure-volume relationship: peak elastance (within-animal Rϭ0.98; between-animals Rϭ0.99), preload recruitable stroke work , and peak of the first derivative of pressure corrected for end-diastolic volume (within-animal Rϭ0.88; between-animals Rϭ0.91). The correlation of peak inertial EIVPD with these indices was also high (all RϾ0.75). Load dependence of EIVPDs was studied in another 5 animals in which consecutive beats obtained during load manipulation were analyzed. During caval occlusion (40% EDV reduction), dP/dt max , ejection fraction, and stroke volume significantly changed, whereas peak EIVPD remained constant. Aortic occlusion (40% peak LV pressure increase) significantly modified dP/dt max , ejection fraction, and stroke volume; a nearly significant trend toward decreasing peak EIVPD was observed (Pϭ0.06), whereas inertial EIVPD was unchanged (Pϭ0.6). EIVPD beat-to-beat and interobserver variabilities were 2Ϯ12% and 5Ϯ11%, respectively. Conclusions-Doppler-derived

For the first time, ejection IVPGs can be accurately visualized and measured by Doppler-echocardiography. Important aspects of the dynamic interaction among myocardial performance, load mechanics, and ejection dynamics can be assessed in the clinical setting using this method.