title: Heart failure in left-sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment.
abstract: OBJECTIVE
  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.
  
  
  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].
  
  
  CONCLUSIONS
  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.
authors: Department of Cardiology, INSERM, ERI-12, Amiens University Hospital, 80054 Amiens Cédex 1, France.
authors: Georges
authors: G
authors: Nadji
authors: Dan
authors: D
authors: Rusinaru
authors: Jean-Paul
authors: JP
authors: Rémadi
authors: Antoine
authors: A
authors: Jeu
authors: Claire
authors: C
authors: Sorel
authors: Christophe
authors: C
authors: Tribouilloy
mesh_terms: D015897:Comorbidity; D016001:Confidence Intervals; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome