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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.

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\,≤q\,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.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03740532
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Soumis le : vendredi 29 juillet 2022 - 15:26:02
Dernière modification le : vendredi 5 août 2022 - 12:02:14

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Yohann Bohbot, Gilbert Habib, Cécile Laroche, Elisabeth Stöhr, Catherine Chirouze, et al.. 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.. European Journal of Heart Failure, European Society of Cardiology (Wiley), 2022, 24 (7), pp.1253--1265. ⟨10.1002/ejhf.2525⟩. ⟨hal-03740532⟩

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