title: Lead-related infective endocarditis: factors influencing the formation of large vegetations.
abstract: OBJECTIVE
  The presence of intracardiac lead vegetations (ILV) is one of the important criteria for diagnosis of lead-related infective endocarditis (LRIE). The objective of the present study was to evaluate risk factors of ILV and their impact on vegetation size.
  
  
  RESULTS
  Clinical data of 500 patients with LRIE undergoing transvenous lead extraction in 2006-15 were retrospectively analysed. The study population consisted of 352 patients with the presence of vegetations (giant, >3 cm; large, 2.0-2.9 cm; moderate-sized, 1.0-1.9 cm; and small, <1 cm) and 148 patients without ILV. We identified risk factors for vegetation occurrence and ILV size. Intracardiac lead vegetations were found more frequently in younger patients (P < 0.05), slightly more often in women (P = 0.084), and less commonly in patients with atrial fibrillation (P < 0.05). Intracardiac lead vegetation occurred significantly more frequently in patients with intracardiac lead abrasion (OR 2.373; 95% CI [1.497-3.765]; P < 0.001) and much less frequently in the concomitant presence of pocket infection (PI) (OR 0.127; 95% CI [0.074-0.218]; P < 0.00). Large vegetations were significantly more common in patients with renal failure (RF) (P < 0.001), heart failure (P < 0.001), implantable cardioverter defibrillator (P < 0.05), and loops of the leads (P < 0.001).
  
  
  CONCLUSIONS
  Intracardiac lead abrasion is one of the most common factors influencing the occurrence of ILV. Metabolic disorders in patients with RF, heart failure, defibrillation leads, and loops of the leads were found to contribute to the formation of large vegetations. In LRIE patients, ILVs were less frequently detected in the presence of concomitant PI, indicating a different mechanism of LRIE development in patients with and without vegetations.
authors.affiliation: Department of Medicine and Health Sciences Kielce, The Jan Kochanowski University, Kielce, Poland.|Second Department of Cardiology, Swietokrzyskie Cardiology Center, Grunwaldzka St. 45, 25-736 Kielce, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Polewczyk
authors.affiliation: Second Department of Cardiology, Silesian Medical University, Zabrze, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jachec
authors.affiliation: Department of Cardiology, Medical University, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tomaszewski
authors.affiliation: Department of Cardiology, Medical University, Lublin, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Brzozowski
authors.affiliation: Department of Cardiac Surgery, Medical University, Lublin, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Czajkowski
authors.affiliation: First Department of Pediatrics, District Hospital, Kielce, Poland.
authors.forename: Aneta Maria
authors.initials: AM
authors.lastname: Polewczyk
authors.affiliation: Department of Medicine and Health Sciences Kielce, The Jan Kochanowski University, Kielce, Poland.|Second Department of Cardiology, Swietokrzyskie Cardiology Center, Grunwaldzka St. 45, 25-736 Kielce, Poland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.affiliation: Department of Cardiology, Medical University, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kutarski
mesh_terms: D000367:Age Factors; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects; D016009:Chi-Square Distribution; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D018572:Disease-Free Survival; D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
keywords: Cardiac implantable electronic devices; Infection; Intracardiac lead vegetations; Risk factors; Transvenous lead extraction