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Multivalve infective endocarditis in intravenous drug using patients: an epidemiological study
Isa Khan1,2, Elizabeth Brookes1, Nima Yaftian2
1Department of Cardiothoracic Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
QJM : Monthly Journal of the Association of Physicians
|September 6, 2021
Summary
Infective endocarditis in intravenous drug users (IVDU) often involves multiple heart valves, significantly increasing mortality risk. Early suspicion of multivalvular disease is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Infective endocarditis (IE) is a serious condition, complicated by intravenous drug use (IVDU).
- Social factors associated with IVDU present unique clinical challenges in managing IE.
Purpose of the Study:
- To characterize contemporary patients with IVDU-associated IE.
- To determine long-term outcomes and identify mortality risk factors in this population.
Main Methods:
- Retrospective observational cohort study at St Vincent's Hospital Melbourne (SVHM) from 1999-2015.
- Follow-up until January 2021, analyzing all-cause mortality using Kaplan-Meier survival and Cox proportional hazards analysis.
Main Results:
- High rate of multivalvular IE (18.98%) in the IVDU population.
- Multivalvular IE showed a dose-dependent increased risk of mortality (HR=4.73 for two valves, HR=14.19 for three valves).
- 1-year survival was 83.78%, and 15-year survival was 64.98%.
Conclusions:
- IVDU-associated IE frequently involves multiple valves, posing diagnostic challenges on echocardiography.
- Multivalvular involvement is a significant predictor of increased mortality in IVDU patients.
- Clinicians must consider multivalve involvement and higher mortality risk in IVDU patients when managing IE.
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