title: Comparison of Outcome of Possible Versus Definite Infective Endocarditis Involving Native Heart Valves.
abstract: There are very few data on the prognosis of possible versus definite infective endocarditis (IE). We studied data from 365 consecutive patients with IE involving native heart valve seen in an academic institution from 1990 to 2012. Patients were classified according to the modified Duke criteria for IE: patients with possible IE (n = 101, 28%) and those with definite IE (n = 264, 72%). Patients with possible IE were older than those with definite IE (66 ± 15 vs 62 ± 16, p = 0.05). A causative microorganism was identified in 66% of patients with possible IE versus all patients with definite IE (p <0.0001) and only 41% had major echocardiographic criteria (vs 100%; p <0.0001). Overall, 139 patients died over a mean ± SD follow-up of 3.9 ± 4.5 years (median 2.2, interquartile range 5.9 years). Patients with possible and definite IE had a similar risk of death. Independent predictors of long-term mortality were increasing age (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01 to 1.04; p = 0.0009), vegetation length >15 mm (HR 1.87, 95% CI 1.14 to 3.06; p = 0.01), and stroke (HR 4.10, 95% CI 1.84 to 9.17; p = 0.0006), whereas infection of mitral valve (HR 0.57, 95% CI 0.34 to 0.94; p = 0.03) and surgery (HR 0.43, 95% CI 0.19 to 0.99; p = 0.05) were associated with a better prognosis. Patients with definite IE and those with possible IE who did not undergo surgery had a worse prognosis than their counterparts with surgery. In conclusion, unselected patients with possible IE (Duke criteria) had a similar prognosis than those with definite IE.
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France. Electronic address: lfau@med.univ-tours.fr.
authors.forename: Lauriane
authors.initials: L
authors.lastname: Pericart
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bourguignon
authors.affiliation: Service de Maladies Infectieuses, Centre Hospitalier Universitaire Bretonneau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Clementy
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006351:Heart Valves / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors