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Periannular extension of infective endocarditis
Catherine Graupner1, Isidre Vilacosta, JoséAlberto SanRomán
1Hospital Universitario San Carlos, Madrid, Spain.
Objectives:
This prospective study was designed to assess the current clinical course, risk factors, microbiologic profile and echocardiographic findings of patients with left-sided endocarditis and perivalvular complications.
Background:
Periannular complications worsen the prognosis of patients with endocarditis. The relation between these complications and the clinical and microbiologic data has not been clearly defined.
Methods:
In this clinical cohort study, 211 patients with left-sided endocarditis, according to the Duke criteria, were prospectively recruited. All patients underwent conventional and transesophageal echocardiography. The mean follow-up interval was 151 days.
Results:
Perivalvular complications were detected in 78 patients (37%). The incidence of periannular extension of infection in native and prosthetic valves was 29% and 55%, respectively. The presence of prosthesis (relative risk [RR] 1.88, 95% confidence interval [CI] 1.35 to 2.64) and previous endocarditis (RR 1.78, 95% CI 1.16 to 2.7) were the only pre-existing heart conditions associated with perivalvular complications. Aortic infection (RR 1.8, 95% CI 1.23 to 2.66) and the development of atrioventricular (AV) block (RR 2.55, 95% CI 1.91 to 3.41) were related with the existence of these complications. Coagulase-negative staphylococci were very common in patients with perivalvular complications (RR 1.77, 95% CI 1.21 to 2.59), and small vegetations were more frequent in these patients (RR l.45, 95% CI 0.95 to 2.22). An operation was more frequently performed in patients with perivalvular complications, but mortality was similar in patients with and without these complications.
Conclusions:
Aortic infection, prosthetic endocarditis, new AV block and coagulase-negative staphylococci were independent risk factors of periannular complications. The period between symptom onset and diagnosis, the incidence of pericardial effusion and persistent signs of infection were similar between patients with and without perivalvular complications. Patients with perivalvular complications did not demonstrate a difference in the presence or size of vegetations or the frequency of embolism. An operation was more frequently performed in these patients, but mortality was similar in both groups.
Insights
Perivalvular complications in left-sided endocarditis are linked to prosthetic valves, previous infections, and aortic infections. These complications did not increase mortality but often required surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- Periannular complications significantly worsen the prognosis of patients diagnosed with endocarditis.
- The precise relationship between these complications and clinical/microbiologic data remains inadequately defined.
Purpose of the Study:
- To evaluate the clinical course, risk factors, microbiologic profile, and echocardiographic findings in patients experiencing left-sided endocarditis with perivalvular complications.
- To identify independent risk factors associated with the development of periannular complications in endocarditis patients.
Main Methods:
- A prospective clinical cohort study involving 211 patients diagnosed with left-sided endocarditis using Duke criteria.
- All participants underwent conventional and transesophageal echocardiography.
- The study maintained a mean follow-up period of 151 days.
Main Results:
- Perivalvular complications were identified in 37% of patients, with higher incidence in prosthetic valves (55%) compared to native valves (29%).
- Independent risk factors for perivalvular complications included prosthetic valve presence, prior endocarditis, aortic infection, and development of atrioventricular (AV) block.
- Coagulase-negative staphylococci were more prevalent in patients with complications; surgery was more frequent, but mortality rates were similar between groups.
Conclusions:
- Aortic infection, prosthetic endocarditis, new AV block, and coagulase-negative staphylococci are independent risk factors for periannular complications.
- Perivalvular complications did not significantly alter vegetation size, embolism frequency, or overall mortality, despite increased surgical intervention.
- The timing of diagnosis and incidence of pericardial effusion did not differ between patients with and without perivalvular complications.