Prognostic value of residual vegetation after antibiotic treatment for infective endocarditis: A retrospective cohort study. (May 2020) - Houard, Valérie
Highlights: Of patients with non-operated infective endocarditis with vegetation at diagnosis, about half will have residual vegetation at the end of treatment. Persistence of vegetation has no clear prognostic impact in itself. The increase in the size of the vegetation is associated with poorer survival. A residual vegetation size greater than 10 mm is associated with a poorer survival. Abstract: Background: The prognostic impact of residual vegetation (RV) after medical treatment for endocarditis remains unknown. Methods: 134 consecutive patients hospitalized for infective endocarditis, not surgically treated, with the presence of vegetation at diagnosis, were included retrospectively. The follow-up started at the end of antibiotic treatment when healing was complete. The presence or absence of RV was assessed at this time. The primary endpoint was a composite of the occurrence of embolic events, recurrence of endocarditis, or death from any cause. Results: Eighty-five patients were men (63%), mean age was 69 ± 15 years, and median follow-up was 16.3 (IQR: 5–30) months. Sixty-six patients (49%) had RV, 15 (11%) had RV > 10 mm and nine (7%) had RV with an increase in size relative to that of the diagnosis. The primary endpoint occurred in 23 patients (35%) in the group with RV, and in 16 patients (24%) without RV, which was not statistically relevant (HR 1.70; 95% confidence interval (CI) 0.89–3.22; p = 0.10). Based on univariate Cox regression analysis, the occurrence of the primary endpoint was associated with RV that increased (HR 3.90 95% CI 1.61–9.43; p < 0.01), RV size (HR 1.05; 95% CI 1.01–1.09; p < 0.01) or RV > 10 mm (HR 3.35; 95% CI 1.51–7.39; p < 0.01). Only RV > 10 mm remained significant in multivariate Cox regression: HR3.29; 95% CI 1.20–8.96; p = 0.02. Conclusions: RV is frequent but has no clear prognostic impact in itself; however, its size, particularly in comparison with the start-of-treatment data, merits particular attention as being potentially associated with increased risk.