Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2022 Jul;24(7):1253-1265.
doi: 10.1002/ejhf.2525. Epub 2022 May 16.

Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry

Yohann Bohbot  1   2 , Gilbert Habib  3   4 , Cécile Laroche  5 , Elisabeth Stöhr  6 , Catherine Chirouze  7 , Marta Hernandez-Meneses  8 , Maria Melissopoulou  9 , Bülent Mutlu  10 , Valentina Scheggi  11 , Luísa Branco  12 , Carmen Olmos  13 , Graciela Reyes  14 , Michal Pazdernik  15 , Bernard Iung  16   17 , Rouguiatou Sow  18 , Maja Mirocevic  19 , Patrizio Lancellotti  20 , Christophe Tribouilloy  1   2 ; EORP EURO-ENDO Registry Investigators Group
Collaborators, Affiliations
Comment

Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry

Yohann Bohbot et al. Eur J Heart Fail. 2022 Jul.

Abstract

Aims: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry.

Methods and results: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73-3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39-2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12-0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20-0.41; p < 0.001).

Conclusion: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

Keywords: Congestive heart failure; EURO-ENDO; Early surgery; Infective endocarditis; Outcome; Survival.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan–Meier 1‐year survival curves (A) in the overall study population and (B) in the propensity‐matched cohort (for age, sex, and Charlson index). CHF, congestive heart failure.
Figure 2
Figure 2
Kaplan–Meier 1‐year survival curves for patients with congestive heart failure according to management (early surgery vs. medical treatment).
See this image and copyright information in PMC

Comment on

References

    1. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012;379:965–75. - PubMed
    1. Habib G. Management of infective endocarditis. Heart. 2006;92:124–30. - PMC - PubMed
    1. Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J, et al. Early predictors of in‐hospital death in infective endocarditis. Circulation. 2004;109:1745–9. - PubMed
    1. Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart. 2002;88:53–60. - PMC - PubMed
    1. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al.; ESC Scientific Document Group . 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio‐Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128. - PubMed

Publication types