Device-related infective endocarditis in cardiac resynchronization therapy recipients — Single center registry with over 2500 person-years follow up. (15th January 2017)

• Record Type: Journal Article
• Authors: Jędrzejczyk-Patej, Ewa; Mazurek, Michał; Kowalski, Oskar; Sokal, Adam; Kozieł, Monika; Adamczyk, Karolina; Przybylska-Siedlecka, Katarzyna; Morawski, Stanisław; Liberska, Agnieszka; Szulik, Mariola; Podolecki, Tomasz; Kowalczyk, Jacek; Kalarus, Zbigniew; Lenarczyk, Radosław
• Is Part Of: International journal of cardiology. Volume 227(2017)
• Page Start: 18
• Page End: 24
• Publication Date: 2017-01-15
• Subjects: Cardiac resynchronization therapy -- Device-related infective endocarditis -- Heart failure -- Incidence -- Risk factors; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.11.029
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aim: To assess incidence, predisposing factors and outcomes of cardiac device-related infective endocarditis (CDRIE) in patients undergoing cardiac resynchronization therapy (CRT). Methods and results: High-volume, single-center cardiology database was screened to identify all CDRIE cases, based on modified Duke criteria, amongst 765 consecutive CRT implantations between 2002 and 2015 (70.8% de novo implantations, 13.7% and 15.5% up-grades from pacemaker and implantable cardioverter–defibrillator [ICD], respectively). During the median follow-up (FU) of 1207 days (range: 256–2664) overall 38 CDRIE (4.97%) cases were identified (incidence: 15/1000 person-years). Multivariate Cox regression model, incorporating significant baseline differences as covariates (model 1), demonstrated that both up-grade from ICD to CRT and higher baseline NYHA class were independently associated with increased risk of CDRIE (adjusted HR 4.29, 95%CI 1.93–9.57; and HR 2.43, 95%CI 1.32–4.49, respectively). In the second model (including all differences with P < 0.2) up-grade from ICD (HR 4.36, 95%CI 1.96–9.69), higher NYHA class (HR 2.04, 95%CI 1.11–3.75), hypertrophic cardiomyopathy (HR 5.85, 95% CI 1.46–23.52), lower baseline hemoglobin level (HR 0.68, 95%CI 0.50–0.94) and chronic obstructive pulmonary disease (HR 2.46, 95%CI 1.05–5.77) were all independently associated with higher risk of CDRIE. All-cause mortality in patients with CDRIE was significantly higher than in subjects without infective complications (68.4% vs. 33.7%, P < 0.001), and 50% of patients with CDRIE died during index hospitalization. Conclusions: The prevalence of CDRIE in CRT recipients is almost 5% within 3.5 years post implantation. Up-grade from ICD and high baseline NYHA class flag up patients at high-risk of CDRIE. CRT-related infective complications are associated with very poor prognosis.