Heart failure in left‐sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment

Abstract

AimsAlthough congestive heart failure (CHF) represents the most common cause of death in native valve infective endocarditis (IE), recent data on the outcome of IE complicated by CHF are lacking. We aimed to analyse the characteristics and prognosis of patients with left-sided native valve IE complicated by CHF and to evaluate the impact of early surgery on 1 year outcome. Methods and resultsTwo hundred and fifty-nine consecutive patients with definite left-sided native valve IE according to the Duke criteria were included in this analysis. When compared with patients without CHF (n ¼ 151), new heart murmur, high comorbidity index, aortic valve IE, and severe valve regurgitation were more frequently observed in CHF patients (n ¼ 108, 41.6%). Mitral valve IE, embolic events and neurological events were less frequent in CHF patients. Congestive heart failure was independently predictive of in-hospital [OR 3.8 (1.7 -9.0); P ¼ 0.0013] and 1 year mortality [HR 1.8 (1.1 -3.0); P ¼ 0.007]. Early surgery was performed in 46% of CHF patients with a peri-operative mortality of 10%. In the CHF group, comorbidity index, Staphylococcus aureus IE, uncontrolled infection, and major neurological events were univariate predictors of 1 year mortality. Early surgery was independently associated with improved 1 year survival ConclusionLeft-sided native valve IE complicated by CHF is more frequent in aortic IE and is associated with severe regurgitation. Congestive heart failure is an independent predictor of in-hospital and 1 year mortality. In CHF patients, early surgery is independently associated with reduced mortality and should be widely considered to improve outcome.--

Association Between Valvular Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Heart Failure

“…Clinical characteristics previously associated with the development of HF in patients with infective endocarditis include new heart murmur, aortic valve infective endocarditis, high comorbidity index, and severe valvular regurgitation. 22 Our findings confirm these earlier results and suggest that a greater degree of new valvular regurgitation was related to the development of HF. Of note, preexisting heart conditions, such as native-valve disease, presence of a prosthetic valve, congenital heart disease, and a causative microorganism such as Staphylococcus aureus,…”

“…9,[21][22][23] In the present work, HF occurred in 33% of definite cases of infective endocarditis, with a high percentage of severe (NYHA class III or IV) symptoms occurring shortly after diagnosis of endocarditis. Clinical characteristics previously associated with the development of HF in patients with infective endocarditis include new heart murmur, aortic valve infective endocarditis, high comorbidity index, and severe valvular regurgitation.…”

“…The in-hospital mortality rates reported in smaller studies of left-sided infective endocarditis and HF have ranged from 24% to 43% 7,21,22,27 and have been associated with uncontrolled infection, major neurologic event, and S aureus infective endocarditis. 22 Later onset of HF in the course of infective endocarditis has also been associated with higher mortality.…”

“…In a recent, single-center study without adjustment for selection or survival bias, valvular surgery was performed in 46% of patients with left-sided infective endocarditis and HF, which was also associated with lower in-hospital and 1-year mortality but not related to the severity of HF. 22 An earlier study used propensity matching to adjust for characteristics of patients treated with surgery and found that the survival benefit of surgery on 6-month outcome in infective endocarditis was limited to those patients with severe(NYHA class III or IV) HF, with no survival benefit in patients with no or mild HF. 2 In the current study, the association between surgery and survival for HF in patients with infective endocarditis was apparent across the spectrum of HF severity.…”

Infective Endocarditis in Low- and Middle-Income Countries

“…[1][2][3] IE also frequently causes debilitating morbidities, such as heart failure, stroke and renal failure requiring dialysis, which contribute to increased mortality and disability adjusted life years (DALYs). [3][4][5][6][7] The spectrum of causative microorganisms and underlying risk factors for IE has shifted dramatically in high income countries (HICs). 8,9 Staphylococcal IE now predominates.…”