Background
Methods
Patient selection
Follow-up
Study endpoints
Statistical analysis
Results
Patient characteristics
Demographic and clinical characteristics of 363 patients with IE | |
---|---|
Age (years), mean ± SD | 65 ± 15 |
Gender (women), n (%) | 123 (34) |
BMI, mean ± SD | 25.0 ± 4.1 |
Renal failure, n (%) | 96 (26) |
Mild n (%) | 41 (43) |
Moderate n (%) | 34 (35) |
Severe n (%) | 14 (15) |
On dialysis n (%) | 7 (7) |
Arterial hypertension, n (%) | 212 (59) |
Previous malignancies, n (%) | 79 (22) |
Drug abuse, n (%) | 43 (12) |
Diabetes, n (%) | 68 (18) |
Dyslipidemia, n (%) | 109 (30) |
Pacemaker, n (%) | 41 (11) |
Oral anticoagulant therapy, n (%) | 91 (25) |
Clinical and echocardiographic characteristics of 363 episodes of IE | |
Prosthetic valve, n (%) | 132 (36) |
First episode of IE, n (%) | 330 (90) |
Systemic embolism, n (%) | 141 (39) |
Cerebral embolism, n (%) | 67 (47) |
Perivalvular extension, n (%) | 84 (23) |
Severe valvular dysfunction, n (%) | 172 (47) |
Vegetation length (mm), mean ± SD | 9.1 ± 7.6 |
Ejection Fraction (%), mean ± SD | 56.7 ± 10.0 |
TAPSE (mm), mean ± SD | 20.8 ± 5.6 |
Euroscore II | 12.4 ± 16.5 |
Type of valve n (%) | Site of infection n (%) | Degree of valvular dysfunction (stenosis/regurgitation) | ||
---|---|---|---|---|
Absent n (%) | Mild or moderate n (%) | Severe n (%) | ||
Native 231 (63%) | Aortic 106 (29%) | 17 (5) | 30 (8) | 59 (16) |
Mitral 108 (29%) | 10 (3) | 34 (9) | 64 (17) | |
Tricuspid 17 (5%) | 2 (1) | 6 (2) | 9 (2) | |
Prosthetic 132 (37%) | Aortic 87 (24%) | 23 (6) | 38 (11) | 26 (7 |
Mitral 39 (11%) | 8 (2) | 19 (5) | 12 (3) | |
Tricuspid 6 (2%) | 0 (0) | 4 (2) | 2 (1) |
Microbiology
Etiologic agent | N (%) |
---|---|
Streptococcus Viridans | 62 (17) |
Streptococcus Bovis | 25 (7) |
Staphylococcus Aureus | 64 (18) |
Negative Coagulase Staphylococci | 46 (13) |
Enterococci | 65 (18) |
Other | 27 (7) |
Negative cultures | 74 (20) |
Total | 363 (100) |
Surgical treatment
Mortality
HR | 95% CI | p | ||
---|---|---|---|---|
Univariate analysis (n = 363) | ||||
Female gender | 1.2 | 1.0 | 1.4 | 0.023 |
Age > 70 years | 2.1 | 1.4 | 3.2 | 0.001 |
Euroscore II > 10 | 3.1 | 2.1 | 4.6 | 0.001 |
Chronic renal failure | 1.9 | 1.3 | 2.9 | 0.001 |
Diabetes | 1.7 | 1.1 | 2.7 | 0.009 |
Oral anticoagulant therapy | 1.7 | 1.2 | 2.7 | 0.005 |
Presence of pacemaker | 2.2 | 1.4 | 3.6 | 0.001 |
Ejection fraction < 40% | 3.1 | 1.8 | 5.4 | 0.001 |
TAPSE < 19 | 2.4 | 1.5 | 3.9 | 0.001 |
Double valve infection | 1.8 | 1.2 | 2.9 | 0.007 |
Prosthetic infection | 1.7 | 1.1 | 2.5 | 0.015 |
Procalcitonin levels > 0.22 mg/dl | 1.9 | 1.2 | 3.0 | 0.003 |
PCR > 83 mg/dl | 1.6 | 1.0 | 2.5 | 0.037 |
Enterococcal infection | 1.6 | 1.0 | 2.5 | 0.022 |
Streptococcal infection | 0.34 | 0.1 | 0.6 | 0.002 |
Exclusion from surgery if indicated | 7.4 | 3.2 | 17.3 | 0.001 |
Multivariate analysis (n = 325) | ||||
Age* | 1.033 | 1.01 | 1.056 | 0.003 |
Drug abuse | 3.40 | 1.41 | 8.13 | 0.006 |
EUROSCORE II* | 1.017 | 1.009 | 1.025 | 0.0006 |
Double valve infection | 2.07 | 1.21 | 3.54 | 0.008 |
Streptococcal infection | 0.49 | 0.26 | 0.92 | 0.028 |
Major non-fatal adverse event rate and new infection rate
HR | 95% CI | p | ||
---|---|---|---|---|
Major non-fatal adverse events (112 patients), univariate analysis | ||||
Age | 1.02 | 1.00 | 1.03 | 0.001 |
Hypertension | 1.46 | 1.06 | 2.03 | 0.02 |
History of cancer | 1.56 | 1.11 | 2.20 | 0.009 |
Major non-fatal adverse events (112 patients), multivariate analysis | ||||
Age | 1.49 | 1.06 | 2.118 | 0.022 |
Recurrent episodes of IE (19 patients), univariate analysis | ||||
Staphylococcus aureus infection | 4.8 | 1.9 | 11.9 | 0.001 |
Right-sided endocarditis | 7.4 | 2.9 | 18.9 | 0.001 |
Spondylodiscitis | 6.8 | 2.6 | 17.8 | 0.004 |
Drug abuse | 10.3 | 4.1 | 25.6 | 0.001 |
Recurrent episodes of IE (19 patients), multivariate analysis | ||||
Drug abuse | 8.5 | 2.3 | 31 | 0.001 |
Echocardiographic follow-up
Site of infection | p | |||
---|---|---|---|---|
Aortic (n = 50) | Mitral (n = 39) | Tricuspid (n = 6) | ||
Gender (women), n (%) | 9 (18) | 7 (18) | 0 (0) | 0.5 |
Age (years), mean ± SD | 61.5 ± 14.8 | 60.3 ± 12.2 | 61.6 ± 12.5 | 0.7 |
Severe valvular dysfunction, n (%) | 23 (46) | 25 (64) | 3 (50) | 0.2 |
Paravalvular extension, n (%) | 13 (26) | 5 (13) | 0 (0) | 0.1 |
Vegetation length (mm), mean ± SD | 7.7 ± 6.2 | 10.2 ± 7.9 | 26.3 ± 13.3 | 0.008 |
Second infected valve, n (%) | 4 (8) | 5 (13) | 1 (17) | 0.6 |
Ejection Fraction (%), mean ± SD | 59.1 ± 8.0 | 60.9 ± 8.5 | 58.3 ± 6.6 | 0.5 |
TAPSE (mm), mean ± SD | 20.8 ± 6.2 | 23.2 ± 5.3 | 21.2 ± 6.9 | 0.2 |
Euroscore II | 7.3 ± 6.3 | 5.6 ± 9.1 | 4.3 ± 2.5 | 0.035 |
Surgery, n (%) | 42 (84) | 34 (87) | 6 (100) | 0.5 |
Ejection Fraction (%) at follow-up, mean ± SD | 58.9 ± 8.3 | 55.9 ± 9.1 | 55.1 ± 11.0 | 0.2 |
Severe valvular dysfunction at follow-up, n (%) | 0 (0) | 4 (10) | 0 (0) | 0.03 |
Echocardiographic follow-up | No (n = 268) | Yes (n = 95) | p value |
---|---|---|---|
Female gender, n (%) | 107 (40) | 16 (17) | < 0.001 |
Age (years), mean ± SD | 66.8 ± 15.1 | 61.0 ± 13.5 | < 0.001 |
Euroscore II, mean ± SD | 14.5 ± 18.2 | 6.4 ± 7.5 | < 0.001 |
Site of infection | NS | ||
Aortic | 143 (53) | 50 (53) | NS |
Mitral | 108 (40) | 41 (41) | NS |
Tricuspidal | 17 (7) | 6 (6) | NS |
Ejection Fraction (%), mean ± SD | 55.6 ± 10.3 | 59.8 ± 8.1 | NS |
TAPSE (mm), mean ± SD | 20.3 ± 5.4 | 21.9 ± 5.9 | NS |
Vegetation length (mm), mean ± SD | 8.8 ± 7.2 | 9.9 ± 8.6 | NS |