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Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience
Fausto Pizzino1, Umberto Paradossi1, Giancarlo Trimarchi2
1Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio-Regione Toscana, 54100 Massa, Italy.
Insights
Infective endocarditis patients with heart failure or embolic events face higher risks of major adverse events. IE-associated heart failure also increased the risk of death in this vulnerable patient group.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Medicine
Background:
- Infective endocarditis (IE) presents significant risks including embolic events (EEs), uncontrolled infection, and heart failure (HF).
- Understanding predictors of adverse outcomes in IE is crucial for patient management.
Purpose of the Study:
- To investigate the association of IE-associated heart failure (IE-aHF) and embolic events (EEs) with major adverse events (MAEs) and all-cause death.
- To identify independent predictors of mortality in patients with IE.
Main Methods:
- A cohort of 102 patients with IE and a surgical indication was enrolled between October 2015 and December 2018.
- The primary endpoint was a composite of MAEs (all-cause death, hospitalizations, IE relapses).
- The secondary endpoint was all-cause death.
Main Results:
- IE-aHF and EEs were independently associated with MAEs (p < 0.05 for both).
- Kaplan-Meier analysis showed significantly worse MAE-free survival in patients with EEs and IE-aHF (p < 0.01).
- IE-aHF, C-reactive protein (CRP) levels, left ventricular ejection fraction (LVEF), abscess, and prosthetic detachment were independently associated with all-cause death.
Conclusions:
- IE-aHF and EEs are significant independent predictors of MAEs in IE patients.
- IE-aHF also independently predicts all-cause death, highlighting its critical role in prognosis.
Background:
Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF).
Methods:
Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of major adverse events (MAEs) including all-cause death, hospitalizations, and IE relapses. The secondary endpoint was all-cause death.
Results:
A total of 102 patients (66 ± 14 years) were enrolled: 50% with IE on prosthesis, 33% with IE-associated heart failure (IE-aHF), and 38.2% with EEs. IE-aHF and EEs were independently associated with MAEs (HR 1.9, 95% CI 1.1-3.4, p = 0.03 and HR 2.1, 95% CI 1.2-3.6, p = 0.01, respectively) and Kaplan-Meier survival curves confirmed a strong difference in MAE-free survival of patients with EEs and IE-aHF (p < 0.01 for both). IE-aHF (HR 4.3, 95% CI 1.4-13, p < 0.01), CRP at admission (HR 5.6, 95% CI 1.4-22.2, p = 0.01), LVEF (HR 0.9, 95% CI 0.9-1, p < 0.05), abscess (HR 3.5, 95% CI 1.2-10.6, p < 0.05), and prosthetic detachment (HR 4.6, 95% CI 1.5-14.1, p < 0.01) were independently associated with the all-cause death endpoint.
Conclusions:
IE-aHF and EEs were independently associated with MAEs. IE-aHF was also independently associated with the secondary endpoint.
