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Comparison of Outcome of Possible Versus Definite Infective Endocarditis Involving Native Heart Valves
Lauriane Pericart1, Anne Bernard1, Thierry Bourguignon1
1Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
Insights
Patients with possible infective endocarditis (IE) have a similar long-term prognosis to those with definite IE. Key mortality predictors include age, vegetation length, and stroke, while mitral valve infection and surgery improve outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Medicine
Background:
- Limited data exist on the prognosis of possible versus definite infective endocarditis (IE).
- IE is a serious infection affecting heart valves, with varying diagnostic certainty.
Purpose of the Study:
- To compare the long-term prognosis of patients with possible IE versus definite IE.
- To identify predictors of mortality in IE patients.
Main Methods:
- Retrospective study of 365 native heart valve IE patients (1990-2012).
- Classification based on modified Duke criteria: possible IE (n=101) vs. definite IE (n=264).
- Analysis of mortality risk and independent predictors over a mean follow-up of 3.9 years.
Main Results:
- Patients with possible IE were older and less likely to have identified microorganisms or major echocardiographic criteria compared to definite IE.
- Overall mortality risk was similar between possible and definite IE groups.
- Independent predictors of mortality included increasing age, vegetation length >15 mm, and stroke. Mitral valve infection and surgery were associated with better prognosis.
Conclusions:
- Unselected patients with possible IE (Duke criteria) exhibit a similar prognosis to those with definite IE.
- Surgical intervention and mitral valve involvement appear to confer a better long-term outlook in IE patients.
Abstract:
There are very few data on the prognosis of possible versus definite infective endocarditis (IE). We studied data from 365 consecutive patients with IE involving native heart valve seen in an academic institution from 1990 to 2012. Patients were classified according to the modified Duke criteria for IE: patients with possible IE (n = 101, 28%) and those with definite IE (n = 264, 72%). Patients with possible IE were older than those with definite IE (66 ± 15 vs 62 ± 16, p = 0.05). A causative microorganism was identified in 66% of patients with possible IE versus all patients with definite IE (p <0.0001) and only 41% had major echocardiographic criteria (vs 100%; p <0.0001). Overall, 139 patients died over a mean ± SD follow-up of 3.9 ± 4.5 years (median 2.2, interquartile range 5.9 years). Patients with possible and definite IE had a similar risk of death. Independent predictors of long-term mortality were increasing age (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01 to 1.04; p = 0.0009), vegetation length >15 mm (HR 1.87, 95% CI 1.14 to 3.06; p = 0.01), and stroke (HR 4.10, 95% CI 1.84 to 9.17; p = 0.0006), whereas infection of mitral valve (HR 0.57, 95% CI 0.34 to 0.94; p = 0.03) and surgery (HR 0.43, 95% CI 0.19 to 0.99; p = 0.05) were associated with a better prognosis. Patients with definite IE and those with possible IE who did not undergo surgery had a worse prognosis than their counterparts with surgery. In conclusion, unselected patients with possible IE (Duke criteria) had a similar prognosis than those with definite IE.