Clinical significance of congestive heart failure in prosthetic valve endocarditis. An Algeria multicenter study

Abstract

We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies. A total of 239 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 97 were prosthetic. Fifty-four (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis. Persistent infection (odds ratio = 3.6; 95% confidence interval, 1.9–6.9) and heart failure (odds ratio = 3; 95% confidence interval, 1.5–5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio = 2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio = 2.5; 95% confidence interval, 1.1–5.8), abscess (odds ratio = 3.6; 95% confidence interval, 1.4–9.5), diabetes mellitus (odds ratio = 2.9; 95% confidence interval, 1.1–7.7), and cardiac surgery (odds ratio = 0.2; 95% confidence interval, 0.1–0.5). The incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.