Outcome Of Infective Endocarditis Research Articles

Occurrence and Outcome of Infective Endocarditis after Surgical Compared to Transcatheter Pulmonary Valve Implantation in Congenital Heart Disease.

Background: Conflicting data exist on the occurrence and outcome of infective endocarditis (IE) after pulmonary valve implantation. Objectives: This study sought to assess the differences between transcatheter pulmonary valve implantation (TPVI) and surgical pulmonary valve replacement (SPVR). Methods: All patients ≥ 4 years who underwent isolated pulmonary valve replacement between 2005 and 2018 were analyzed based on the data of a major German health insurer (≈9.2 million insured subjects representative of the German population). The primary endpoint was a composite of IE occurrence and all-cause death. Results: Of 461 interventions (cases) in 413 patients (58.4% male, median age 18.9 years [IQR 12.3-33.4]), 34.4% underwent TPVI and 65.5% SPVR. IE was diagnosed in 8.0% of cases during a median follow-up of 3.5 years. Risk for IE and all-cause death was increased in patients with prior IE (p < 0.001), but not associated with age (p = 0.50), sex (p = 0.67) or complexity of disease (p = 0.59). While there was no difference in events over the entire observational time period (p = 0.22), the time dynamics varied between TPVI and SPVR: Within the first year, the risk for IE and all-cause death was lower after TPVI (Hazard Ratio (HR) 95% CI 0.19 (0.06-0.63; p = 0.006) but increased over time and exceeded that of SPVR in the long term (HR 10.07 (95% CI 3.41-29.76; p < 0.001). Conclusions: Patients with TPVI appear to be at lower risk for early but higher risk for late IE, resulting in no significant difference in the overall event rate compared to SPVR. The results highlight the importance of long-term specialized care and preventive measures after both interventions.

Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience.

Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF). Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of major adverse events (MAEs) including all-cause death, hospitalizations, and IE relapses. The secondary endpoint was all-cause death. A total of 102 patients (66 ± 14 years) were enrolled: 50% with IE on prosthesis, 33% with IE-associated heart failure (IE-aHF), and 38.2% with EEs. IE-aHF and EEs were independently associated with MAEs (HR 1.9, 95% CI 1.1-3.4, p = 0.03 and HR 2.1, 95% CI 1.2-3.6, p = 0.01, respectively) and Kaplan-Meier survival curves confirmed a strong difference in MAE-free survival of patients with EEs and IE-aHF (p < 0.01 for both). IE-aHF (HR 4.3, 95% CI 1.4-13, p < 0.01), CRP at admission (HR 5.6, 95% CI 1.4-22.2, p = 0.01), LVEF (HR 0.9, 95% CI 0.9-1, p < 0.05), abscess (HR 3.5, 95% CI 1.2-10.6, p < 0.05), and prosthetic detachment (HR 4.6, 95% CI 1.5-14.1, p < 0.01) were independently associated with the all-cause death endpoint. IE-aHF and EEs were independently associated with MAEs. IE-aHF was also independently associated with the secondary endpoint.

Clinical Characteristics and Outcome of Infective Endocarditis among Intravenous Drug Abusers after 6 months

Clinical Characteristics and Outcome of Infective Endocarditis among Intravenous Drug Abusers after 6 months

Changing Paradigms in Epidemiology, Microbiology, and Outcomes of Infective Endocarditis

Changing Paradigms in Epidemiology, Microbiology, and Outcomes of Infective Endocarditis

Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short- and Long-Term Outcomes.

Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010-2020. We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures - Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests. Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20-3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07-3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14-5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05-2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35-13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01-1.91, p = 0.043). In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.

Clinical presentation, etiology and outcome of infective endocarditis in a tertiary hospital in Malaysia

Clinical presentation, etiology and outcome of infective endocarditis in a tertiary hospital in Malaysia

Sex differences in characteristics, microbiology, management, and outcomes in infective endocarditis

Abstract Background Infective endocarditis affects male patients more frequently, yet female sex has been associated with higher mortality rate in prior smaller studies. Unselected nationwide studies on sex differences in infective endocarditis are sparse and may help identify sex-related and universal prophylactic strategies. Purpose To investigate sex related differences in patient characteristics, practice patterns and outcomes in patients with infective endocarditis. Methods Between 2010–2020, we identified and characterized all patients with infective endocarditis according to sex. We used data from the Danish national registries including microbiological data, and outcome. Frailty was assessed by the sum of cardiovascular and non-cardiovascular comorbidities in each patient using the Hospital Frailty Risk Score. Mortality was compared in unadjusted analyses using Kaplan-Meier estimates for 90-day mortality following hospital admission and 5-year mortality following hospital discharge. In adjusted analyses, Cox regression was used for comparison of 90-day and 5-year mortality. Results We identified 6,259 patients with infective endocarditis including 2,047 (32.7%) female patients and 4,212 (67.3%) male patients. Female patients were older (median age 75.0 years (IQR 64.3–82.2 vs. 71.7 years (IQR 61.7–78.9) and more frail (Intermediate frailty: 36.5% vs. 33.1%, High frailty: 11.4% vs. 9.2%, p&amp;lt;0.001). Female patients had lower education level, lower income and were more likely to live alone. Female patients had less cardiovascular comorbidity than male patients such as ischemic heart disease (25.2% vs. 34.8%), congestive heart failure (20.3% vs. 24.0%), prior myocardial infarction (7.8% vs. 14.3%), prosthetic heart valve (16.5% vs. 20.3%), and CIED (12.2% vs. 18.7%) (p&amp;lt;0.01). Staphylococcus aureus was the most common microorganism in both sexes (34.6% vs. 28.8%), but fewer female patients had Enterococcus species than male patients (10.5% vs. 18.1%). Female patients were less often surgically treated (14.0% vs. 21.2%). The cumulative 90-day incidences of mortality from hospital admission were 30.9% (95% CI 28.9%–32.9%) in females and 23.6% (95% CI 22.3%–24.9%) in males (Figure 1). The cumulative 5-year incidences of mortality from hospital discharge were 59.8% (95% CI 57.4%–62.0%) in female patients and 53.0% (95% CI 51.3%–54.6%) in male patients. In adjusted analysis, female sex was associated with increased 90-day mortality (adj. HR 1.22, 95% CI 1.10–1.36), but no difference was found in 5-year mortality (adj. HR 1.02, 95% CI 0.93–1.12). Conclusion In infective endocarditis, female sex is associated with an increased 90-day mortality despite adjusting for age and frailty. However, this association is not found in long-term mortality. Female patients differ from male patients with lower prevalence of Enterococcus infective endocarditis and lower rates of surgery. Further research is needed to understand why these differences persist.

Abstract 12736: Prevalence, Characteristics, and Outcomes of Infective Endocarditis in Patients With Liver Disease in the United States

Introduction: Infective endocarditis (IE) is common in patients with liver disease. Data regarding IE in liver disease are limited. Hypothesis: We analyzed IE admissions to determine inpatient outcomes among patients with liver disease in the United States. Methods: We used the 2017 National Readmission Database to identify index admission of adults with IE, based on the International Classification of Disease, 10th revision codes. The primary outcome was 30-day readmission. Secondary outcomes were mortality and predictors of hospitalization readmission. Results: We identified 40,413 IE admissions. Figure 1 presents prevalence of variables associated with liver disease in this cohort. Patients who were readmitted were more likely to have a history of hepatitis C virus (19.4% vs 12.3%, p &lt; 0.001), hyponatremia (25% vs 21%, p &lt; 0.001), and thrombocytopenia (20.3% vs 16.3%, p &lt;0.001). After adjusting for age, hypertension, heart failure, diabetes mellitus, and end stage renal disease, hyponatremia (odds ratio (OR): 1.25; 95% confidence intervals [CI]: 1.17 to 1.35; p &lt; 0.001) and thrombocytopenia (OR: 1.16; 95% CI: 1.08 to 1.24; p &lt; 0.001) correlated with higher odds of 30-day readmission. Mortality was higher among patients with hyponatremia (29% vs 22%, p &lt; 0.001), thrombocytopenia (29% vs 17%, p &lt; 0.001), coagulopathy (12% vs 5%, p &lt; 0.001), cirrhosis (6% vs 4%, p &lt; 0.001), ascites (7% vs 3%, p &lt;0.001), liver failure (18% vs 3%, p &lt; 0.001), and portal hypertension (3% vs 1.5%, p &lt; 0.001) (Figure 2). Conclusions: Important liver disease related variables correlate with higher risks of hospital readmission and mortality in patients with IE. Targeting such variables may improve outcomes in this patient population.

Contemporary Outcomes and Predictors of Inpatient Mortality for Infective Endocarditis Occurring in Renal Transplant Recipients in the United States

Renal transplant (RT) recipients are susceptible to infections because of immunosuppression. The literature regarding the epidemiology and outcomes of infective endocarditis (IE) in RT recipients is limited. We analyzed the National Inpatient Sample in the United States to study IE in RT and identify risk factors for inpatient mortality and IE development in RT patients. All patients ≥18years who had IE with and without RT between 2007 and 2019 were identified from the National Inpatient Sample. The demographics, co-morbidities, length of stay, hospital costs, and mortality of IE patients with RT were compared with IE patients without RT. Predictors of inpatient mortality for RT recipients with IE were analyzed. Between 2007 and 2019, there were 777,245 hospitalizations for IE, of which 3,782 had RT. The IE in RT cohort was younger than the general IE population and had higher proportions of males, non-White races, and Hispanic ethnicity, and higher burden of co-morbidities, but similar inpatient mortality rates. On multivariate analysis, Staphylococcal IE (adjusted odds ratio [aOR]2.26, 95% confidence interval [CI] 1.2 to 4.3, p=0.015), stroke (aOR6.4, 95% CI 2.7 to 15.3, p<0.001), anemia (aOR2.3, 95% CI 1.3 to 4.0, p=0.004), and shock (aOR6.3, 95% CI 3.3 to 11.9, p<0.001) were associated with greater inpatient mortality, whereas Streptococcal endocarditis (aOR0.37, 95% CI 0.1 to 0.9, p=0.038) was associated with lower inpatient mortality. In conclusion, RT patients with IE were younger and had more severe co-morbidities compared with IE patients without RT. Staphylococcal IE, presence of shock and stroke worsened the prognosis in these patients.

Clinical features and outcomes of infective endocarditis: a single-centre experience.

Infective endocarditis (IE) may present with a broad spectrum of symptoms and signs and several tools can be used for diagnosis. Many protocols can be used for in-hospital and out-patient management. The aim of this study was to assess the clinical features, tools used and outcomes of patients diagnosed with IE in one of the tertiary-care university hospitals. This study included 90 consecutive patients admitted to the Cardiology Department in a tertiary-care university hospital in Egypt with a diagnosis of IE. The mean age of the studied population was 36.72 years and 76.67% were males. The most common underlying condition was valvular heart disease (48.89%), followed by intravenous drug use (26.67%) and the most common risk factor was smoking (48.89%). The most common clinical presentation was fever (69.67%), followed by dyspnoea (55.56%), and the mean duration from symptom onset until admission was 13.28 ± 9.29 days. Positive cultures were encountered in 45.56% of patients. Surgery was indicated in 91.11% of the patients but it was performed in only 28.89%. Almost a third of patients (34.44%) died in the hospital. After one year of follow up, a further 8.47% of the patients had died, 11.86% had heart failure and 6.78% had undergone a re-do surgery. Nowadays IE tends to affect a younger group of patients and valvular heart disease is the main underlying condition. The mortality rate due to IE is high in developing countries and IE does not have only immediate and short-term complications, its effects extend to a longer period of time.

Risk and Outcome of Infective Endocarditis in Streptococcal Bloodstream Infections according to Streptococcal Species.

This study aimed to identify which streptococcal species are closely associated with infective endocarditis (IE) and to evaluate risk factors for mortality in patients with streptococcal IE. We performed a retrospective cohort study of all patients with streptococcal bloodstream infection (BSI) from January 2010 to June 2020 in a tertiary hospital in South Korea. We compared clinical and microbiological characteristics of streptococcal BSIs according to the diagnosis of IE. We performed multivariate analysis to evaluate the risk of IE according to streptococcal species and risk factors for mortality in streptococcal IE. A total of 2,737 patients were identified during the study period, and 174 (6.4%) were diagnosed with IE. The highest IE prevalence was in patients with Streptococcus mutans BSI (33% [9/27]) followed by S. sanguinis (31% [20/64]), S. gordonii (23% [5/22]), S. gallolyticus (16% [12/77]), and S. oralis (12% [14/115]). In multivariate analysis, previous IE, high-grade BSI, native valve disease, prosthetic valve, congenital heart disease, and community-onset BSI were independent risk factors for IE. After adjusting for these factors, S. sanguinis (adjusted OR [aOR], 7.75), S. mutans (aOR, 5.50), and S. gallolyticus (aOR, 2.57) were significantly associated with higher risk of IE, whereas S. pneumoniae (aOR, 0.23) and S. constellatus (aOR, 0.37) were associated with lower risk of IE. Age, hospital-acquired BSI, ischemic heart disease, and chronic kidney disease were independent risk factors for mortality in streptococcal IE. Our study points to significant differences in the prevalence of IE in streptococcal BSI according to species. IMPORTANCE Our study of risk of infective endocarditis in patients with streptococcal bloodstream infection demonstrated that Streptococcus sanguinis, S. mutans, and S. gallolyticus were significantly associated with higher risk of infective endocarditis. However, when we evaluated the performance of echocardiography in patients with streptococcal bloodstream infection, patients with S. mutans and S. gordonii bloodstream infection had a tendency of low performance in echocardiography. There are significant differences in the prevalence of infective endocarditis in streptococcal bloodstream infection according to species. Therefore, performing echocardiography in streptococcal bloodstream infection with a high prevalence of, and significant association with, infective endocarditis is desirable.

Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012).

Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. IE cases from 13 European countries were included. Two periods were considered: 2000-2006 and 2008-2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern-Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49-74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p< 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period. Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE).

Epidemiology, microbiology, and outcomes of infective endocarditis in atertiary center in Jordan.

Infective endocarditis (IE) is arelatively rare but serious and life-threatening disease with substantial mortality and morbidity despite progress in diagnostic and treatment techniques. The aim of this study is to investigate the epidemiology, clinical characteristics, microbiological profile, and outcomes of IE patients in atertiary care facility in Jordan, the Jordan University Hospital (JUH). This is aretrospective case series study which was conducted at JUH. Atotal of 23patients with either definite or possible IE according to the Modified Duke Criteria were included in the study. Medical records were reviewed, and relevant information was collected. Descriptive data analysis was performed. Our study identified atotal of 23patients with infective endocarditis; 65.2% were males, with amean age of 40.4years. The majority of patients had an underlying cardiac disease (60.9%), with the most common being congenital heart diseases (17.4%). The most commonly affected valves were the left-side heart valves, with the mitral valve (52.2%) being the most common followed by the aortic valve (34.8%). The most common organism detected in blood culture was Streptococcus viridans (21.7%) followed by methicillin-resistant Staphylococcus aureus. The most common complications among the patients were heart failure and septic shock, and the mortality rate among the patients was 13%. In patients with endocarditis, Streptococcus viridans is the most common culture-positive bacteria at JUH. One third of our patients needed surgical intervention and the mortality rate was 13%.

Peculiar clinical and diagnostic features of infective endocarditis in Yemen: Comparative analysis with a Western University Hospital.

The aim of this study was to describe the pattern, characteristics, and outcomes of infective endocarditis (IE) in Yemen and compare the results with the findings of a Western university hospital. Patients (pts) with a final diagnosis of IE observed in Al-Thawra Sanaa Cardiac Center were prospectively enrolled in 1-year time period. Clinical and diagnostic findings were compared to clinical and diagnostic data of 50 pts with IE observed at Sapienza University Hospital in Rome, Italy. The mean age was 38 ± 6. Predisposing factors for IE were rheumatic heart disease (RHD) in 34 pts (68%), congenital heart disease in 9 pts (18%), prosthetic valve IE in 4 pts (8%), and previous IE in 3 pts (6%). Transthoracic echocardiography (TTE) was done in 50 pts and transesophageal echocardiography (TEE) in 25. Blood cultures were taken in all pts and were positive in 3 pts (6%) and negative in 47 (94%). TTE was positive in 34/50 pts (68%) and TEE in 20/25 (80%). Compared to Sapienza University pts, Al-Thawra Cardiac Center pts had a younger age (p = 0.003), more predisposing RHD (p = 0.0004), less prosthetic heart valves IE (p = 0.002), and more negative blood cultures (p = 0.0001). IE is still a common disease in Yemen among RHD pts and affects the younger age group. It has severe complications which need early diagnosis and proper management. Echocardiography is of prime diagnostic value in the absence of positive blood cultures. An effort should be made to prevent rheumatic fever and RHD.

Abstract 10996: Clinical Characteristics and Outcomes of Infective Endocarditis Among Intravenous Drug Abusers - A Single-Center Experience

Introduction: There are limited data regarding intravenous drug abuse (IVDA) associated with infective endocarditis (IE). The study aimed to compare IVDA to non-IVDA-associated IE regarding the differences in clinical profile, microbiology, echocardiography, and clinical outcomes among patients admitted with IE. Methods: 90 patients from January 2019 to December 2021 who met the Modified Duke ‘‘definitive’’ criteria for IE were included. Demographic, clinical, and laboratory data were collected. All patients underwent transthoracic echocardiography and transesophageal echocardiogram whenever indicated. In-hospital morbidity and mortality were reported. Results: Among the 90 patients included, 24 (26.7%) had a history of IVDA. IVDA-group were younger (27 vs 40 years, P&lt;0.0001), males (95.8% vs 69.7%, P=0.01), and more likely to have concomitant HCV and HIV infections compared to non-IVDA-group (50% vs 3%, P&lt;0.0001). Methicillin-resistant staphylococcus aureus (MRSA) percentage was higher in IVDA-group (54.2% vs 16.7%, P= 0.0004). Tricuspid value was the most common valve (79.2%) affected in IVDA-group whereas mitral followed by aortic valves were most commonly involved in non-IVDA-group (43.9% and 31.8% respectively). Embolic events at admission were more frequent in IVDA-group (83.3% vs 15.2%, P&lt;0.0001). Septic shock and embolic events (58.3%, 37.5% consecutively) are the most common causes of in-hospital morbidity among IVDA-group. In-hospital mortality was significantly higher among IVDA-group compared to non-IVDA-group (58.3% vs 25.8%, P=0.04). Conclusion: The demographic, microbiological, and echocardiographic profile is quite different in IVDA and non-IVDA-group. Larger studies are required to confirm these data, especially in low- and middle-income countries.

Outcomes of infective endocarditis in patients with and without pericardial effusion: a National Inpatient Sample study

Abstract Introduction Pericardial effusion (PE) in patients with infective endocarditis (IE) has been shown to be an independent risk factor for severe complications, however no significant association with mortality has been established. Our study aims to study the significance of pericardial effusion in patients with IE. Methods We performed a retrospective analysis using the United States National Inpatient Sample (NIS) database to identify all the hospital admissions with IE using ICD 10 codes and divided them into two groups based on the presence of PE. The outcomes of interest were in-hospital mortality, in-hospital complications, need for cardiac surgery, and length of stay (LOS). Results A total of 381,300 patients were hospitalized from 2016 to 2019 with IE, of whom 10,370 developed PE. Mean age of patients in the PE group was 51 years and in non-PE group was 61 years with males and Caucasian race being predominant in both groups. PE group had higher rates of in-hospital death (12.7% vs 9%, P≤0.001) and longer in-hospital stay (12 days vs 7 days, P≤0.001) compared to non-PE group. The rates of cardiac surgery were higher in PE group (26.1% vs 8.4%, P≤0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher in PE group [Table 1]. Conclusion Our study shows that presence of PE in patients with IE is a predictor for in-hospital mortality, length of stay, and need for cardiac surgery. Also, these patients are at higher risk for heart failure, heart block, cardiogenic shock and embolic stroke. Funding Acknowledgement Type of funding sources: None.

Risk predictors and outcomes of infective endocarditis among adult patients with congenital heart disease

Abstract Background Infective endocarditis (IE) is a serious disease associated with increased morbidity and mortality. Patients with adult congenital heart disease (ACHD) have been reported to be at a particularly increased risk of infective endocarditis (IE). Purpose To investigate the risk predictors of IE, and the long-term risk of IE among ACHD patients aged 18–65 years, compared with matched controls without ACHD, in a nationwide setting. Methods All patients with ACHD in Sweden born in years 1952–1999 and who survived until 18 years of age were followed in the National Patient Register and Cause of Death Register until year 2017. For each case of ACHD, approximately ten controls without ACHD were randomly selected from the Total Population Register and matched by birth year and sex. The study population was followed from 18 years of age and until a first time diagnosis of IE, death or end of study. Both comorbidities and occurrence of ACHD related surgery were collected from 1970 and onwards. Cox proportional hazard models were used to predict the risk of IE. Results Altogether, 36,189 ACHD patients and 403,962 controls without ACHD were included. A total of 706 (1.95%) ACHD patients and 147 (0.04%) controls developed IE during a median follow-up of 15.5 (interquartile range (IQR) 6.9–28.5) years (ACHD) and 15.5 (IQR 7.5–28.5) years (controls). ACHD patients were somewhat younger at age of IE diagnosis compared with controls, median age 33.9 (IQR 25.4–44.1) years in ACHD vs 39.8 (IQR 30.6–52.0) years in controls. The overall risk of IE was markedly higher among ACHD patients compared with controls, with a hazard ratio (HR) of 54.8 (95% confidence interval (CI), 45.9–65.5). More than one third of the ACHD patients with IE (n=272, 38.5%) had undergone any kind of previous congenital heart surgery whereof 122 (44.9%) had undergone valve replacement (mechanical/biological) prior to IE. In ACHD patients, the most important risk predictors for IE were ACHD related cardiac surgery and valve replacement surgery, HR 117 (95% CI 93.0–148) and HR 74.8 (95% CI 56.4–99.2), respectively. Diabetes mellitus, previous ischemic stroke and presence of an intracardiac electronic device also predicted the risk of IE, however, they were less important predictors (diabetes: HR 1.69, 95% CI 1.01–2.82, ischemic stroke: HR 1.75, 95% CI 1.21–2.52, electronic device: HR 1.59, 95% CI 1.05–2.39). Conclusion The risk of developing IE was found to be almost 55 times higher in patients with ACHD aged 18–65 years compared with matched controls. Previous ACHD related surgery and valve replacement were the most significant risk predictors. These results underscore the need of continuous clinical follow-up as well as the need of further research to prevent this serious complication of ACHD. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The work was supported by grants from the Swedish state under an agreement between the Swedish government and country councils, the ALF-agreement (grant numbers 236611 and 917361); and the Swedish Heart-Lung Foundation (grant number: 20180644 and 20200521).

Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016–2020

BackgroundWe performed a study to assess sex-differences in incidence (2016–2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status.MethodsOurs was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM.ResultsFrom 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74–2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54–3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018).The presence of T2DM was not associated with IHM in men or women.ConclusionsT2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women.

Five-Year Cardiovascular Outcomes after Infective Endocarditis in Patients with versus without Drug Use History.

Background: Disparities in treatment and outcomes of infective endocarditis (IE) between people who use drugs (PWUD) and non-PWUD have been reported, but long-term data on cardiovascular and cerebrovascular outcomes are limited. We aim to compare 5-year rates of mortality, cardiovascular and cerebrovascular events after IE between PWUD and non-PWUD. Methods: Using data from the TriNetX Research Network, we examined 5-year cumulative incidence of mortality, myocardial infarction, heart failure, atrial fibrillation/flutter, ventricular tachyarrhythmias, ischemic stroke, and intracranial hemorrhage in 7132 PWUD and 7132 propensity score-matched non-PWUD patients after a first episode of IE. We used the Kaplan–Meier estimate for incidence and Cox proportional hazards models to estimate relative risk. Results: Matched PWUD were 41 ± 12 years old; 52.2% men; 70.4% White, 19.8% Black, and 8.0% Hispanic. PWUD had higher mortality vs. non-PWUD after 1 year (1–3 year: 9.2% vs. 7.5%, p = 0.032; and 3–5-year: 7.3% vs. 5.1%, p = 0.020), which was largely driven by higher mortality among female patients. PWUD also had higher rates of myocardial infarction (10.0% vs. 7.0%, p < 0.001), heart failure (19.3% vs. 15.2%, p = 0.002), ischemic stroke (8.3% vs. 6.3%, p = 0.001), and intracranial hemorrhage (4.1% vs. 2.8%, p = 0.009) compared to non-PWUD. Among surgically treated PWUD, interventions on the tricuspid valve were more common; however, rates of all outcomes were comparable to non-PWUD. Conclusions: PWUD had higher 5-year incidence of cardiovascular and cerebrovascular events after IE compared to non-PWUD patients. Prospective investigation into the causes of these disparities and potential harm reduction efforts are needed.

Infective endocarditis and COVID-19: the impact of SARS-CoV-2 infection on diagnostics, course, and prognosis

Aim. To study the impact of coronavirus disease 2019 (COVID-19) pandemic on hospitalization rates, diagnosis, and outcomes of infective endocarditis (IE) with a subanalysis of IE course in combination with COVID-19.Material and methods. This prospective cohort study included 168 patients with definite or probable IE (DUKE 2015) hospitalized in the V.V. Vinogradov City Clinical Hospital from July 2017 to July 2022. All patients underwent a conventional examination in accordance with current clinical guidelines. We studied clinical, paraclinical and etiological parameters, as well as outcomes.Two clinical observations of the combination of IE and COVID-19 are presented.Results. When assessing the local registry of patients with IE, a trend towards an increase in hospitalizations rate of IE in 2021-2022 was shown, with a decrease during the period of long-term lockdowns in Moscow and a subsequent surge after their cancellation. Patients with IE during the COVID-19 pandemic had a more favorable clinical profile, a 2-fold increase in IE diagnosis (due to late hospitalization), frequent detection of Staphylococcus aureus MSSA (32,6%), and frequent surgical treatment (up to 87,6% with a combination of IE and COVID-19), as well as high in-hospital mortality, but without a tendency to increase (30,4%). Clinical observations of IE and COVID-19 combination are presented, which demonstrates the contribution of COVID-19 as the only risk factor for native tricuspid valve IE in a patient without predisposing causes, as well as a factor in the unfavorable prognosis for native aortic valve IE after the addition of COVID-19, which led to lethal outcome.Conclusion. The present study demonstrates the profile of patients with IE and COVID-19 depending on the epidemiological situation of COVID-19 and the association with SARS-CoV-2 infection. The data obtained make it possible to discuss the potential relationship between COVID-19 and IE. The "endocarditis team" determines the timely implementation of surgery and the absence of an increase in inhospital mortality, regardless of the epidemiological situation.