Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients.
OBJECTIVE
There have been no studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies.


METHODS
A total of 639 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 257 were prosthetic. Of the 257 episodes, 145 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis and identified the prognostic factors of in-hospital mortality in these patients.


RESULTS
Persistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0.2; 95% confidence interval, 0.1-0.5).


CONCLUSIONS
The incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain. Electronic address: javihouston@yahoo.es.
Javier
J
López
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
Teresa
T
Sevilla
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Isidre
I
Vilacosta
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
Héctor
H
García
Servicio de Medicina Interna-Infecciosas, Hospital de La Princesa, Madrid, Spain.
Cristina
C
Sarriá
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Eduardo
E
Pozo
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Jacobo
J
Silva
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
Ana
A
Revilla
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
Grétel
G
Varvaro
Servicio de Medicina Interna-Infecciosas, Hospital de La Princesa, Madrid, Spain.
María
M
del Palacio
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
Itziar
I
Gómez
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
José Alberto
JA
San Román
D000368:Aged; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000382:microbiology* / Q000401:mortality; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000401:mortality