Abstract 13899: Isolated Tricuspid Valve Endocarditis Within A Patient Population At High Risk Of Intravenous Drug Use: A Retrospective Cohort Study

Abstract

Introduction: Tricuspid valve endocarditis (TVE) is associated with intravenous drug use (IVDU) and complicated by numerous disease processes and societal impacts. Our academic medical center treats many TVE patients, predominantly with history of IVDU. We hypothesize that adverse outcomes related to TVE are associated with myriad co-morbidities and that a multidisciplinary approach integrating addiction medicine may improve outcomes and decrease in-hospital mortality. Methods: We conducted a medical record query of patients found to have infective endocarditis involving only the tricuspid valve and treated between July 2018 and January 2021. Baseline demographic data, characteristics and complications of TVE, echocardiographic data, and clinical outcomes were measured. Results: A total of 73 TVE patients were included; 32 were male, 41 were female. Mean age was 36.6 ± 11.8 years. Fifty (68%) patients reported a definite history of IVDU. TVE was associated with tricuspid regurgitation (TR) but TR severity did not correlate with worse outcome (p=0.238). Comorbidities included pulmonary septic emboli, heart failure (HF), pulmonary embolism, abscess, respiratory failure, cardiac arrest, and pneumonia. Staphylococcus aureus was the most common pathogen (57/80, 71.3%) with similar rates of MSSA and MRSA. Factors associated with in-hospital mortality included presence of prosthetic TV (p=0.005), prior diagnosis of HF (p=0.012), and MRSA infection (p=0.028). (Table 1) Medication-assisted treatment of opioid use disorder was associated with a lower rate of leaving the hospital against medical advice (p=0.006). Conclusions: Given the complexity of disease processes associated with TVE, a multidisciplinary approach to management is necessary. A prospective study following this vulnerable patient population in the inpatient and outpatient setting is warranted to further decrease the morbidity and mortality associated with this devastating disease.