title: Periannular extension of infective endocarditis.
abstract: OBJECTIVE
  This prospective study was designed to assess the current clinical course, risk factors, microbiologic profile and echocardiographic findings of patients with left-sided endocarditis and perivalvular complications.
  
  
  BACKGROUND
  Periannular complications worsen the prognosis of patients with endocarditis. The relation between these complications and the clinical and microbiologic data has not been clearly defined.
  
  
  METHODS
  In this clinical cohort study, 211 patients with left-sided endocarditis, according to the Duke criteria, were prospectively recruited. All patients underwent conventional and transesophageal echocardiography. The mean follow-up interval was 151 days.
  
  
  RESULTS
  Perivalvular complications were detected in 78 patients (37%). The incidence of periannular extension of infection in native and prosthetic valves was 29% and 55%, respectively. The presence of prosthesis (relative risk [RR] 1.88, 95% confidence interval [CI] 1.35 to 2.64) and previous endocarditis (RR 1.78, 95% CI 1.16 to 2.7) were the only pre-existing heart conditions associated with perivalvular complications. Aortic infection (RR 1.8, 95% CI 1.23 to 2.66) and the development of atrioventricular (AV) block (RR 2.55, 95% CI 1.91 to 3.41) were related with the existence of these complications. Coagulase-negative staphylococci were very common in patients with perivalvular complications (RR 1.77, 95% CI 1.21 to 2.59), and small vegetations were more frequent in these patients (RR l.45, 95% CI 0.95 to 2.22). An operation was more frequently performed in patients with perivalvular complications, but mortality was similar in patients with and without these complications.
  
  
  CONCLUSIONS
  Aortic infection, prosthetic endocarditis, new AV block and coagulase-negative staphylococci were independent risk factors of periannular complications. The period between symptom onset and diagnosis, the incidence of pericardial effusion and persistent signs of infection were similar between patients with and without perivalvular complications. Patients with perivalvular complications did not demonstrate a difference in the presence or size of vegetations or the frequency of embolism. An operation was more frequently performed in these patients, but mortality was similar in both groups.
authors.affiliation: Hospital Universitario San Carlos, Madrid, Spain.
authors.forename: Catherine
authors.initials: C
authors.lastname: Graupner
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: JoséAlberto
authors.initials: J
authors.lastname: SanRomán
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ronderos
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mújica
authors.forename: Olga
authors.initials: O
authors.lastname: Sanz
authors.forename: Juan Victor
authors.initials: JV
authors.lastname: Sanmartín
authors.forename: Angel González
authors.initials: AG
authors.lastname: Pinto
mesh_terms: D015331:Cohort Studies; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D005260:Female; D006327:Heart Block / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006351:Heart Valves / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000473:pathology