Abstract
Background . Long-term prognosis of the patients after cardiac surgery is often explained by the relation to the main disease without consideration of possible negative prognostic impact of the post-surgery comorbidity, in particular, new-onset hypertension (HTN). Objective. To assess the risk of HTN development in patients after surgery for infective endocarditis (IE) in a prospective study. A special method of projective classification was used for decrease the contingency bias by application of several decisive rules instead of one. Design and methods . Altogether 92 IE patients (66 male and 26 female) with various valve diseases were retrospectively divided into two groups: fifty patients with HTN composed the first group and forty two formed the comparison group. The post-surgery follow-up period achieved up to 20 years. Initially, 133 pre- and post-surgery characteristics were included in analysis. Results. We found a gender-dependent difference in predictive factors. Out of all 133 factors, only eight presurgery variables and nine characteristics of early post-surgery period, were found to be common for men and women in HTN prediction: age at the time of surgery and symptoms of heart failure (HF) after surgery. For women, significant factors also included absence of thromboembolic events and HF after surgery, presence of permanent atrial fibrillation prior surgery and the education level. For men the variants included left ventricular end-diastolic dimension and pulmonary hypertension (both with the negative prediction value), and interventricular septal thickness and post-surgery size of the right ventricle (both with the positive prediction value), HF and arterial fibrillation paroxysms, presence of presurgery trioventricular block and mitral insufficiency. Conclusions. The projective classification assessment of HTN risk in patients after surgery for IE provided reliable definition of prognostic factors despite the heterogeneous group of patients.
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