Patients with multivalvular infective endocarditis demonstrate adverse cardiac remodeling before surgery with...

Infective endocarditis can result in the destruction of any valve in the heart or damage to multiple valves. However, the scope of valvular damage is not considered in the current guidelines for surgical indications of infective endocarditis. Whether widespread valvular damage in infective endocarditis leads to more severe cardiac remodeling requiring earlier intervention remains unclear. We sought to investigate differences in adverse cardiac remodeling and postoperative outcomes in patients with infective endocarditis involving a single valve versus multiple valves.

From January 2010 to December 2022, 343 patients with infective endocarditis who underwent valve surgery in Beijing Anzhen Hospital were included in our study. The patients were divided into multivalvular infective endocarditis group (n=143) and single-valve infective endocarditis group (n=200) according to the results of preoperative transthoracic echocardiography combined with actual repair or replacement of valves during surgery. Postoperative outcomes of the two groups were compared before and after inverse probability of treatment weighting (IPTW) treatment of baseline data. The primary endpoint was all-cause death and the secondary endpoint was a composite event including death, stroke, reoperation, and recurrence of infective endocarditis. Preoperative echocardiography comprehensively evaluated left ventricular diastolic and systolic function and cardiac remodeling.

The follow-up time of multivalvular infective endocarditis group and single-valve infective endocarditis group was respectively 47.93 and 69.98 months. Left ventricular end-diastolic diameter (6.1 vs. 5.4 cm, P<0.001) and left ventricular end-systolic diameter (4.1 vs. 3.6 cm, P<0.001) were significantly larger in patients with multivalvular infective endocarditis than in patients with single-valve infective endocarditis. Left ventricular mass (254.3 vs. 201.0, P<0.001) and left ventricular mass index (147.1 vs. 119.8, P<0.001) were also significantly greater in patients with multivalvular infective endocarditis. However, left ventricular ejection fraction (60.6% vs. 61.4%, P=0.33) was not different between the two groups. Baseline variables of the two groups were well balanced [standard mean difference (SMD) <10%] after IPTW of baseline data.

Compared with patients with single-valve infective endocarditis, patients with multivalvular infective endocarditis demonstrated more pronounced preoperative left ventricular remodeling trends, lower postoperative survival rates, and reduced event-free survival rates. We propose that patients with multivalvular infective endocarditis may benefit from enhanced cardiac ultrasound surveillance and early surgical intervention before cardiac remodeling progress.