Left-sided native valve infective endocarditis: Influence of age and the presence of underlying heart disease

Abstract

Introduction and objectivesLeft-sided native valve infective endocarditis (LNVIE) epidemiology has been modified as a result of the increase in average age. The aim of our study is to analyse the influence of age and the presence of predisposing heart disease in the prognosis of these patients. MethodsWe analysed a series of 257 cases of LNVIE depending on their age (greater than or equal to 70 years old), both in the overall series and in the subgroup of patients without predisposing heart disease. ResultsMean age was 54.6 (18.6) years. There was an increase in the percentage of cases of older patients between 1987–2000 and 2001–2014 (9.8 vs. 34.8%, p<0.001). These patients present higher prevalence of degenerative valves (50 vs. 22.8%) or not predisposing heart disease (50 vs. 39.9%), p<0.001, health-care associated episodes (41.8 vs. 23.6%, p=0.016), lower rate of surgery (43.7 vs. 63.8%, p=0.005) and higher in-hospital mortality (39.1 vs. 20.7%, p=0.003), with no differences in comorbidities. Older patients who did not have predisposing heart disease also suffered higher in-hospital mortality (47 vs. 22%, p=0.01). Age greater than or equal to 70 years old is an independent predictor of mortality in patients with LNVIE (OR 2.53, 95% CI 1.24–5.15, p=0.011), as in those without previous heart disease (OR 3.98, 95% CI 1.49–10.62, p=0.006). ConclusionsPatients of age greater than or equal to 70 years old and who suffer an LNVIE are becoming more frequent and have a worse prognosis with a lower rate of surgery and higher rates of in-hospital mortality.