Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: A substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry.
EURO-ENDO; congestive heart failure; early surgery; infective endocarditis; outcome; survival
Abstract :
[en] AIMS: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. METHODS AND RESULTS: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age:60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n=698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations>10mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p≤0.019). Patients with CHF experienced higher 30-day and one-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day(OR95%CI=2.37[1.73-3.24];p<0.001) and one-year mortality(HR95%CI=1.69[1.40-2.05];p<0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity(n=618[88.5%] for each group, both p<0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson index, cerebrovascular accident, staphylococcus aureus IE, Streptococcal IE, uncontrolled infection, vegetation size>10mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE(OR95%CI=0.22[0.12-0.38];p<0.001) and in one-year mortality(HR95%CI=0.29[0.20-0.41];p<0.001). CONCLUSION: CHF is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and one-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Bohbot, Yohann ; Department of Cardiology, Amiens University Hospital, Amiens, France. ; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
Habib, Gilbert ; Department of Cardiology, Hôpital de la Timone, Aix-Marseille University, ; Aix Marseille University, IRD, AP-HM, MEPHI, IHU-Mediterranean Infection
Laroche, Cécile; EURObservational Research Programme, European Society of Cardiology, Heart House.
Stöhr, Elisabeth; Department of Cardiology, Heart Center, University of Bonn, Bonn, Germany.
Chirouze, Catherine; Maladies infectieuses et tropicales - Centre Hospitalier Régional Universitaire,
Hernandez-Meneses, Marta; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS,
Melissopoulou, Maria; Department of Cardiology, CHR Citadelle, Bd du 12è de Ligne, Liège, 4000,
Mutlu, Bülent; Department of Cardiology, Marmara University Istanbul Pendik Educational and
Scheggi, Valentina; Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular
Branco, Luísa; Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal.
Olmos, Carmen; Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación
Reyes, Graciela; Echo Lab Department, Hospital de Alta Complejidad en red El Cruce, Florencio
Pazdernik, Michal; Department of Cardiology, IKEM, Prague, Czech Republic, Department of Cardiology,
Iung, Bernard ; Université de Paris and Institut National de la Santé et de la Recherche ; Cardiology Department, Bichat Hospital, AP-HP, Paris, France.
Sow, Rouguiatou; Department of cardiology, Luxembourg Hospital Centre, Luxembourg.
Mirocevic, Maja; Department of cardiology, Clinical Centre of Montenegro, Podgorica, Montenegro.
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Cardiology Department, University Hospital Centre, Centre Hospitalier Universitaire de Liège
Tribouilloy, Christophe; Department of Cardiology, Amiens University Hospital, Amiens, France. ; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: A substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry.
Publication date :
04 May 2022
Journal title :
European Journal of Heart Failure
ISSN :
1388-9842
eISSN :
1879-0844
Publisher :
Wiley-Blackwell, Hoboken, Us nj
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
This article is protected by copyright. All rights reserved.
Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012;379:965–75.
Habib G. Management of infective endocarditis. Heart. 2006;92:124–30.
Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J, et al. Early predictors of in-hospital death in infective endocarditis. Circulation. 2004;109:1745–9.
Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart. 2002;88:53–60.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al.; ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.
Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, et al.; EURO-ENDO Investigators. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40:3222–32.
Nadji G, Rusinaru D, Rémadi JP, Jeu A, Sorel C, Tribouilloy C. Heart failure in left-sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment. Eur J Heart Fail. 2009;11:668–75.
Kiefer T, Park L, Tribouilloy C, Cortes C, Casillo R, Chu V, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA. 2011;306:2239–47.
Habib G, Lancellotti P, Erba PA, Sadeghpour A, Meshaal M, Sambola A, et al.; EURO-ENDO Investigators. The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes. 2019;5:202–7.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classification of prognostic comorbidity for longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285:1441–6.
López J, Sevilla T, Vilacosta I, García H, Sarriá C, Pozo E, Silva J, et al. Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. Rev Esp Cardiol (Engl Ed). 2013;66:384–90.
Gálvez-Acebal J, Rodríguez-Baño J, Martínez-Marcos FJ, Reguera JM, Plata A, Ruiz J, et al.; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI). Prognostic factors in left-sided endocarditis: results from the Andalusian multicenter cohort. BMC Infect Dis. 2010;10:17.
van den Brink F, Hasenaar J, Winia V, Klomp M, Van Vlies B, Nicastia D, et al. Prognostic factors in infective endocarditis in general hospitals in The Netherlands. Neth Heart J. 2016;24:717–21.
Leitman M, Dreznik Y, Tyomkin V, Fuchs T, Krakover R, Vered Z. Vegetation size in patients with infective endocarditis. Eur Heart J Cardiovasc Imaging. 2012;13:330–8.
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, et al.; International Collaboration on Endocarditis-Prospective Cohort study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort study. Arch Intern Med. 2009;169:463–73.
Vallejo Camazón N, Cediel G, Núñez Aragón R, Mateu L, Llibre C, Sopena N, et al. Short- and long-term mortality in patients with left-sided infective endocarditis not undergoing surgery despite indication. Rev Esp Cardiol (Engl Ed). 2020;73:734–40.
Anguera I, Miro JM, Vilacosta I, Almirante B, Anguita M, Munoz P, et al. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality. Eur Heart J. 2005;26:288–97.
Bohbot Y, Peugnet F, Lieu A, Carbone A, Mouhat B, Philip M, et al. Characteristics and prognosis of patients with left-sided native bivalvular infective endocarditis. Can J Cardiol. 2021;37:292–9.
Netzer RO, Altwegg SC, Zollinger E, Tauber M, Carrel T, Seiler C. Infective endocarditis: determinants of long term outcome. Heart. 2002;88:61–6.
Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation. 2005;112:69–75.
Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. JAMA. 2003;290:3207–14.
Slater MS, Komanapalli CB, Tripathy U, Ravichandran PS, Ungerleider RM. Treatment of endocarditis: a decade of experience. Ann Thorac Surg. 2007;83:2074–9.
Pericàs JM, Hernández-Meneses M, Muñoz P, Martínez-Sellés M, Álvarez-Uria A, de Alarcón A, Gutiérrez-Carretero E, et al.; Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES). Characteristics and outcome of acute heart failure in infective endocarditis: focus on cardiogenic shock. Clin Infect Dis. 2021;73:765–74.
Kahveci G, Bayrak F, Mutlu B, Bitigen A, Karaahmet T, Sonmez K, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis. Am J Cardiol. 2007;99:1429–33.
Shiue AB, Stancoven AB, Purcell JB, Pinkston K, Wang A, Khera A, et al. Relation of level of B-type natriuretic peptide with outcomes in patients with infective endocarditis. Am J Cardiol. 2010;106:1011–5.
Bannay A, Hoen B, Duval X, Obadia JF, Selton-Suty C, Le Moing V, et al.; AEPEI Study Group. The impact of valve surgery on short- and long-term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J. 2011;32:2003–15.
