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Factors associated with local invasion in infective endocarditis: a nested case-control study
Abarna Ramanathan1, James C Witten2, Steven M Gordon1
1Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
Summary
Local invasion in infective endocarditis (IE) is linked to specific heart valve issues and certain bacteria. Comorbidities did not significantly influence local invasion in surgically treated IE patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Pathology
Background:
- Infective endocarditis (IE) frequently involves local invasion, leading to complex cardiac complications.
- Understanding factors associated with local invasion is crucial for effective management of IE.
- Previous studies have not fully elucidated the specific patient and disease characteristics contributing to local invasion in surgically treated IE.
Purpose of the Study:
- To identify patient and disease characteristics associated with local invasion in surgically treated infective endocarditis (IE) patients.
- To differentiate factors contributing to local invasion from those related to overall IE severity or patient comorbidities.
Main Methods:
- A nested case-control study design was employed, analyzing data from the Cleveland Clinic IE Registry (January 2013 - June 2016).
- Included patients (≥18 years) underwent surgery for IE. Cases exhibited local invasion (periannular extension, abscess, fistula, pseudoaneurysm), while controls did not.
- Multivariable logistic regression was used to examine associations between selected factors and local invasion.
Main Results:
- Of 511 eligible patients, 215 (42%) had local invasion.
- Factors significantly associated with local invasion included aortic valve involvement (OR 6.23), bioprosthetic valve (OR 3.88), significant paravalvular leak (OR 3.80), new atrioventricular nodal block (OR 3.77), infection with non-viridans streptococci (OR 7.54), and central nervous system emboli (OR 1.85).
- Comorbid conditions were not found to be associated with local invasion.
Conclusions:
- Local invasion in infective endocarditis is primarily associated with intracardiac factors and specific microorganisms.
- Comorbid conditions do not appear to be significant drivers of local invasion in this surgically treated IE cohort.
- These findings highlight the importance of considering valve pathology and causative agents in predicting and managing IE local invasion.
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