Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis. (July 2015)

• Record Type: Journal Article
• Authors: Lauridsen, Trine K.; Park, Lawrence; Tong, Steven Y.C.; Selton-Suty, Christine; Peterson, Gail; Cecchi, Enrico; Afonso, Luis; Habib, Gilbert; Paré, Carlos; Tamin, Syahidah; Dickerman, Stuart; Bayer, Arnold S.; Johansson, Magnus C.; Chu, Vivian H.; Samad, Zainab; Bruun, Niels E.; Fowler, Vance G.; Crowley, Anna Lisa
• Is Part Of: Circulation. Volume 8:Number 7(2015)
• Publication Date: 2015-07
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.114.003397
• Languages: English
• ISSNs: 1941-9651

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p> <italic>Staphylococcus aureus</italic> left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in <italic>S aureus</italic> LNVIE is unknown.</p> </sec> <sec> <title>Methods and Results—</title> <p>Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without <italic>S aureus</italic> IE were matched to those with <italic>S aureus</italic> IE by the propensity of having <italic>S aureus</italic>. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had <italic>S aureus</italic> IE. One-year survival rates were significantly lower for patients with <italic>S aureus</italic> IE overall (57% <italic>S aureus</italic> IE versus 80% non-<italic>S aureus</italic> IE; <italic>P</italic><0.001) and in the propensity-matched cohort (59% <italic>S aureus</italic> IE versus 68% non-<italic>S aureus</italic> IE; <italic>P</italic><0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52–5.40; <italic>P</italic><0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35–6.04; <italic>P</italic>=0.004) were the only independent echocardiographic predictors of in-hospital mortality in <italic>S aureus</italic> LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21–3.68; <italic>P</italic>=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26–3.78; <italic>P</italic>=0.004) were the only independent predictors of 1-year mortality.</p> </sec> <sec> <title>Conclusions—</title> <p> <italic>S aureus</italic> is an independent predictor of 1-year mortality in subjects with LNVIE. In <italic>S aureus</italic> LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.</p> </sec> </abstract>