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Characteristics and Prognosis of Patients With Left-Sided Native Bivalvular Infective Endocarditis
- Source :
- Canadian Journal of Cardiology, Canadian Journal of Cardiology, 2021, 37 (2), pp.292-299. ⟨10.1016/j.cjca.2020.03.046⟩
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- International audience; Background: Most cases of left-sided native valve infective endocarditis (IE) involve a single valve and little is known concerning IE that simultaneously affects the aortic and mitral valves. Methods: We aimed to determine the characteristics, identify the prognostic factors, and define the effect of early surgery for patients with left-sided native bivalvular IE. This analysis included 1340 consecutive patients who presented with definite acute left-sided native valve IE in a 2-centre cohort study. Results: A bivalvular involvement was present in 257 patients (19%). Patients with bivalvular IE had more embolic events (P = 0.044), congestive heart failure (P = 0.016), vegetations, and perivalvular complications (both P < 0.001) than those with monovalvular IE. Early surgery was more frequent for patients with bivalvular IE (P < 0.001). Thirty-day mortality was higher for patients with bivalvular IE than for those with monovalvular IE (24.5% vs 17.6%; P = 0.008), even after adjustment (odds ratio, 1.86 [95% confidence interval, 1.26-2.73]; P < 0.001). Estimated 10-year survival was 70% +/- 1% for monovalvular IE and 59% +/- 3% for bivalvular IE (P = 0.002). Bivalvular IE was still associated with mortality in multivariable Cox analysis, after adjustment for covariates including age, neurological events, congestive heart failure, Staphylococcus spp infection, perivalvular complications, and early surgery (hazard ratio, 1.70 [95% confidence interval, 1.31-2.11]; P < 0.001). Early surgery was associated with increased survival for patients with bivalvular IE (79% +/- 4% vs 35% +/- 6%; P < 0.001). Conclusions: Bivalvular involvement is frequent in left-sided native valve IE, is associated with more embolic events and congestive heart failure than monovalvular IE, and patients are at a high risk of death. Early surgery is associated with improved survival and should be systematically discussed in the absence of contraindication.
- Subjects :
- Male
medicine.medical_specialty
Staphylococcus
[SDV]Life Sciences [q-bio]
Embolism
Improved survival
030204 cardiovascular system & hematology
Risk Assessment
Left sided
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Hospital Mortality
030212 general & internal medicine
Cardiac Surgical Procedures
Contraindication
Heart Failure
Endocarditis
business.industry
Middle Aged
Prognosis
medicine.disease
Outcome and Process Assessment, Health Care
Echocardiography
Native valve
Aortic Valve
Heart failure
Infective endocarditis
Cardiology
Mitral Valve
Female
France
Risk of death
Cardiology and Cardiovascular Medicine
business
Cohort study
Subjects
Details
- ISSN :
- 0828282X and 19167075
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....8d4ed79d52942e1e411032bdc6b67eaf