Presence of conduction abnormalities as a predictor of clinical outcomes in patients with infective endocarditis.
There have been no studies that have assessed the possible correlation between conduction abnormality (CA) and systemic embolism, or the long-term outcomes of patients with infective endocarditis (IE). In this study, 82 consecutive patients with IE and interpretable electrocardiography (ECG) were admitted to Kyungpook National University Hospital from July 2002 to June 2008. ECGs obtained at the time of admission or during hospitalization were analyzed. Patients with CA, which was defined as atrioventricular or intraventricular block, of "new" or "of unknown duration" were considered as those with CA. Composite events were defined as the composite of death and embolic events. Twenty-three (28%) patients had CA classified as new (n = 11) or of unknown duration (n = 12). No significant differences were found between patients with and without CA in terms of age and gender. Mean follow-up duration was 21 ± 23 months. Patients with CA had more frequent embolic events (p = 0.001) and composite events (p = 0.002) during hospitalization, and had more frequent composite events (p < 0.001) during follow-up than those without CA. Kaplan-Meier survival curves showed that patients with CA had a higher composite event rate during follow-up (p = 0.003). However, there was no significant difference between the two groups regarding mortality rates during hospitalization and follow-up. In multivariate analysis, CA was an independent predictor of embolic event rates during hospitalization [odds ratio (OR) 5.198, 95% confidence interval (CI) 1.086-24.867, p = 0.039] and of composite event rates during follow-up (OR 27.168, 95% CI 4.590-160.802, p < 0.001). CA is associated with increased frequency of embolic events during hospitalization and follow-up. Moreover, CA might be a useful predictor of embolic event occurrences during both hospitalization and follow-up.
Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Dongdeukno 200, Chung-Ku, Daegu, 700-721, Korea.
Hyeon Min
HM
Ryu
Myung Hwan
MH
Bae
Sang Hyuk
SH
Lee
Jang Hoon
JH
Lee
Ju Hwan
JH
Lee
Yong Seop
YS
Kwon
Dong Heon
DH
Yang
Hun Sik
HS
Park
Yongkeun
Y
Cho
Shung Chull
SC
Chae
Jae-Eun
JE
Jun
Wee-Hyun
WH
Park
D000328:Adult; D054537:Atrioventricular Block / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004562:Electrocardiography; D004617:Embolism / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D004696:Endocarditis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors