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Heart failure in left‐sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment
Author(s) -
Nadji Georges,
Rusinaru Dan,
Rémadi JeanPaul,
Jeu Antoine,
Sorel Claire,
Tribouilloy Christophe
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp077
Subject(s) - medicine , heart failure , infective endocarditis , cardiology , comorbidity , univariate analysis , aortic valve replacement , endocarditis , aortic valve , surgery , multivariate analysis , stenosis
Aims Although 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 results Two 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 = 151), new heart murmur, high comorbidity index, aortic valve IE, and severe valve regurgitation were more frequently observed in CHF patients ( n = 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 = 0.0013] and 1 year mortality [HR 1.8 (1.1–3.0); P = 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 [HR 0.45 (0.22–0.93); P = 0.03]. Conclusion Left‐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.