Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry

EORP EURO-ENDO Registry Investigators Group

doi:10.1002/ejhf.2525

Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry

EORP EURO-ENDO Registry Investigators Group

Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Aims: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. Methods and results: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73–3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39–2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12–0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20–0.41; p < 0.001). Conclusion: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

Original language	American English
Pages (from-to)	1253-1265
Number of pages	13
Journal	European Journal of Heart Failure
Volume	24
Issue number	7
DOIs	https://doi.org/10.1002/ejhf.2525
State	Published - Jul 2022

Bibliographical note

Funding Information:
This work was supported by Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2020), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2018), Vifor (2019–2022). Conflict of interest: none declared. EURObservational Research Programme EORP Oversight Committee, Registry Executive and Steering Committees of the Data collection was conducted by the EORP department of the ESC: Emanuela Fiorucci, as Project Officer; Viviane Missiamenou, Florian Larras, and Rachid Mir Hassaine, as Data Managers. Statistical analyses were performed by Cécile Laroche. Overall activities were coordinated and supervised by Doctor Aldo P. Maggioni (EORP Scientific Coordinator). Special thanks to the EACVI (European Association of CardioVascular Imaging) and to the ESC Working Group on Valvular Heart Disease for their support. This work was supported by Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2020), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2018), Vifor (2019–2022). Conflict of interest: none declared.

Publisher Copyright:
© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords

Congestive heart failure
EURO-ENDO
Early surgery
Infective endocarditis
Outcome
Survival

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10.1002/ejhf.2525

Cite this

@article{831e0484bc184d038a2d272d81676288,

title = "Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry",

abstract = "Aims: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. Methods and results: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73–3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39–2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12–0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20–0.41; p < 0.001). Conclusion: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.",

keywords = "Congestive heart failure, EURO-ENDO, Early surgery, Infective endocarditis, Outcome, Survival",

author = "{EORP EURO-ENDO Registry Investigators Group} and Yohann Bohbot and Gilbert Habib and C{\'e}cile Laroche and Elisabeth St{\"o}hr and Catherine Chirouze and Marta Hernandez-Meneses and Maria Melissopoulou and B{\"u}lent Mutlu and Valentina Scheggi and Lu{\'i}sa Branco and Carmen Olmos and Graciela Reyes and Michal Pazdernik and Bernard Iung and Rouguiatou Sow and Maja Mirocevic and Patrizio Lancellotti and Christophe Tribouilloy and Gale, {C. P.} and B. Beleslin and A. Budaj and O. Chioncel and N. Dagres and N. Danchin and J. Emberson and D. Erlinge and M. Glikson and A. Gray and M. Kayikcioglu and Maggioni, {A. P.} and Nagy, {V. K.} and A. Nedoshivin and Petronio, {A. S.} and J. Roos-Hesselink and L. Wallentin and U. Zeymer and B. Cosyns and E. Donal and P. Erba and B. Iung and Maggioni, {A. P.} and Popescu, {B. A.} and B. Prendergast and P. Tornos and M. Andarala and C. Berle and A. Brunel-Lebecq and E. Fiorucci and C. Laroche and J. Strahilevitz",

note = "Funding Information: This work was supported by Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2020), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2018), Vifor (2019–2022). Conflict of interest: none declared. EURObservational Research Programme EORP Oversight Committee, Registry Executive and Steering Committees of the Data collection was conducted by the EORP department of the ESC: Emanuela Fiorucci, as Project Officer; Viviane Missiamenou, Florian Larras, and Rachid Mir Hassaine, as Data Managers. Statistical analyses were performed by C{\'e}cile Laroche. Overall activities were coordinated and supervised by Doctor Aldo P. Maggioni (EORP Scientific Coordinator). Special thanks to the EACVI (European Association of CardioVascular Imaging) and to the ESC Working Group on Valvular Heart Disease for their support. This work was supported by Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2020), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2018), Vifor (2019–2022). Conflict of interest: none declared. Publisher Copyright: {\textcopyright} 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",

year = "2022",

month = jul,

doi = "10.1002/ejhf.2525",

language = "American English",

volume = "24",

pages = "1253--1265",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Wiley-Blackwell",

number = "7",

}

Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry. / EORP EURO-ENDO Registry Investigators Group.
In: European Journal of Heart Failure, Vol. 24, No. 7, 07.2022, p. 1253-1265.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure

T2 - a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry

AU - EORP EURO-ENDO Registry Investigators Group

AU - Bohbot, Yohann

AU - Habib, Gilbert

AU - Laroche, Cécile

AU - Stöhr, Elisabeth

AU - Chirouze, Catherine

AU - Hernandez-Meneses, Marta

AU - Melissopoulou, Maria

AU - Mutlu, Bülent

AU - Scheggi, Valentina

AU - Branco, Luísa

AU - Olmos, Carmen

AU - Reyes, Graciela

AU - Pazdernik, Michal

AU - Iung, Bernard

AU - Sow, Rouguiatou

AU - Mirocevic, Maja

AU - Lancellotti, Patrizio

AU - Tribouilloy, Christophe

AU - Gale, C. P.

AU - Beleslin, B.

AU - Budaj, A.

AU - Chioncel, O.

AU - Dagres, N.

AU - Danchin, N.

AU - Emberson, J.

AU - Erlinge, D.

AU - Glikson, M.

AU - Gray, A.

AU - Kayikcioglu, M.

AU - Maggioni, A. P.

AU - Nagy, V. K.

AU - Nedoshivin, A.

AU - Petronio, A. S.

AU - Roos-Hesselink, J.

AU - Wallentin, L.

AU - Zeymer, U.

AU - Cosyns, B.

AU - Donal, E.

AU - Erba, P.

AU - Iung, B.

AU - Maggioni, A. P.

AU - Popescu, B. A.

AU - Prendergast, B.

AU - Tornos, P.

AU - Andarala, M.

AU - Berle, C.

AU - Brunel-Lebecq, A.

AU - Fiorucci, E.

AU - Laroche, C.

AU - Strahilevitz, J.

N1 - Funding Information: This work was supported by Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2020), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2018), Vifor (2019–2022). Conflict of interest: none declared. EURObservational Research Programme EORP Oversight Committee, Registry Executive and Steering Committees of the Data collection was conducted by the EORP department of the ESC: Emanuela Fiorucci, as Project Officer; Viviane Missiamenou, Florian Larras, and Rachid Mir Hassaine, as Data Managers. Statistical analyses were performed by Cécile Laroche. Overall activities were coordinated and supervised by Doctor Aldo P. Maggioni (EORP Scientific Coordinator). Special thanks to the EACVI (European Association of CardioVascular Imaging) and to the ESC Working Group on Valvular Heart Disease for their support. This work was supported by Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2020), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2018), Vifor (2019–2022). Conflict of interest: none declared. Publisher Copyright: © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2022/7

Y1 - 2022/7

N2 - Aims: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. Methods and results: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73–3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39–2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12–0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20–0.41; p < 0.001). Conclusion: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

AB - Aims: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. Methods and results: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73–3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39–2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12–0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20–0.41; p < 0.001). Conclusion: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

KW - Congestive heart failure

KW - EURO-ENDO

KW - Early surgery

KW - Infective endocarditis

KW - Outcome

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85131751367&partnerID=8YFLogxK

U2 - 10.1002/ejhf.2525

DO - 10.1002/ejhf.2525

M3 - Article

C2 - 35508915

AN - SCOPUS:85131751367

SN - 1388-9842

VL - 24

SP - 1253

EP - 1265

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 7

ER -

Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry

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Keywords

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