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Multicenter Study
. 2015 Jul;8(7):e003397.
doi: 10.1161/CIRCIMAGING.114.003397.

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study

Trine K Lauridsen  1 , Lawrence Park  1 , Steven Y C Tong  1 , Christine Selton-Suty  1 , Gail Peterson  1 , Enrico Cecchi  1 , Luis Afonso  1 , Gilbert Habib  1 , Carlos Paré  1 , Syahidah Tamin  1 , Stuart Dickerman  1 , Arnold S Bayer  1 , Magnus C Johansson  1 , Vivian H Chu  1 , Zainab Samad  1 , Niels E Bruun  1 , Vance G Fowler Jr  1 , Anna Lisa Crowley  2
Affiliations
Multicenter Study

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study

Trine K Lauridsen et al. Circ Cardiovasc Imaging. 2015 Jul.

Abstract

Background: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown.

Methods and results: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality.

Conclusions: S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.

Keywords: echocardiography; endocarditis; odds ratio; risk factors; survival analysis.

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Figures

Figure 1
Figure 1. Survival analysis for Staphylococcus aureus Left-sided Native Valve Endocarditis
Kaplan Meier survival curves show significantly lower survival rates for Staphylococcus aureus left-sided native valve infective endocarditis in comparison with other pathogens in the overall, non-matched (A) and propensity-matched cohorts (B). Staphylococcus aureus left-sided native valve infective endocarditis was independently associated with 1-year mortality in both non-matched (C) and propensity-matched cohorts (D). *Cox proportional hazards modeling of 1-year mortality †Stratified Cox proportional hazards modeling of 1-year mortality ‡Adjusted for age, sex, hemodialysis, heart failure, cerebral embolism, moderate or severe mitral or aortic regurgitation, valvular perforation, cardiac abscess, left ventricular ejection fraction<40%, and cardiac surgery.
Figure 2
Figure 2. Cox Proportional Hazards Model of Clinical and Echocardiographic Variables
Independently Associated with In-hospital and 1-Year Mortality for Staphylococcus aureus Left-sided Native Valve Infective Endocarditis (n=202), with Propensity Adjustment for Cardiac Surgery *Native Valve Predisposition includes moderate mitral or aortic regurgitation or stenosis †New York Heart Association ‡Left Ventricular Ejection Fraction
See this image and copyright information in PMC

Comment in

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