Blood culture-negative endocarditis; Diagnosis; Endocarditis; Heart valves; Infective endocarditis; Surgery
Abstract :
[en] AIM: Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). METHODS AND RESULTS: This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. CONCLUSION: The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Kong, William K F ; Department of Cardiology, National University Heart Centre Singapore, Singapore. ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Salsano, Antonio ; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of ; Division of Cardiac Surgery, Ospedale Policlinico San Martino-IRCCS, Largo
Giacobbe, Daniele Roberto ; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. ; Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.
Popescu, Bogdan A ; Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'
Laroche, Cécile; EORP, European Society of Cardiology, Sophia-Antipolis, France.
Duval, Xavier; INSERM Clinical Investigation Center 1425, Université Paris Diderot, Sorbonne ; AEPEI Service de Maladies Infectieuses et Tropicales, APHP, Hôpital Bichat,
Schueler, Robert; Heart Center, University Hospital, Bonn, Germany.
Moreo, Antonella ; Dipartimento CardioToracoVascolare 'De Gasperis', ASST Grande Ospedale
Colonna, Paolo ; Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy.
Piper, Cornelia; Clinic for General and Interventional Cardiology/Angiology, Herz-und
Calvo-Iglesias, Francisco ; Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
Badano, Luigi P ; University of Milano-Bicocca, Milano, Italy. ; Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico
Srdanovic, Ilija; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. ; Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia.
Boutoille, David ; Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital
Huttin, Olivier ; Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, ; CIC-Plurithématique 1433, Inserm U1116, CHRU Nancy, Université de Lorraine, ; INSERM U1254, IADI, Université de Lorraine, Nancy, France.
Stöhr, Elisabeth; Heart Center, University Hospital, Bonn, Germany.
Timóteo, Ana Teresa ; Secretária-Geral Sociedade Portuguesa Cardiologia, Lisbon, Portugal. ; Assistente Hospitalar Graduada Cardiologia, Hospital Santa Marta, Centro ; NOVA Medical School, Lisbon, Portugal.
Vaskelyte, Jolanta-Justina ; Department of Cardiology, Lithuanian University of Health Sciences, Kaunas
Sadeghpour, Anita ; Rajaie Cardiovascular Medical & Research Center, Tehran, Iran. ; Duke Cardiovascular MR Center, Durham, NC, USA.
Poh, Kian Keong ; Department of Cardiology, National University Heart Centre Singapore, Singapore. ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Habib, Gilbert ; Department of Cardiology, APHM, La Timone Hospital, Marseille, France. ; University Hospital of Liege (CHU), Liege, Belgium.
Lancellotti, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Rajaie Cardiovascular Medical & Research Center, Tehran, Iran.
