Highlights
- •Infective endocarditis remains a condition with high inhospital mortality.
- •Echocardiography findings can guide treatment and establish surgical indications.
- •Positive echocardiography in these patients is associated with a poor prognosis.
- •Risk estimation should also consider clinical factors and comorbidities.
- •Closer monitoring is needed in the presence of a positive echocardiography.
Abstract
Background
Echocardiography plays an important role in infective endocarditis (IE) diagnosis
according with the modified Duke criteria. We evaluated the implications of a positive
echocardiography in the prognosis of a cohort of patients with IE.
Methods
Prospective multicentre study in 31 Spanish centres. From January 2008 to September
2016, 3467 patients were included (2765 definite IE, 702 possible IE). The main outcome
was in-hospital mortality. Echocardiography diagnosis was based on modified Duke criteria
for the diagnosis of IE.
Results
Median age was 69 years (interquartile range: 57–77 years). Comorbidity was high (mean
Charlson index 4.7 ± 2.8). Transoesophageal echocardiography was performed in 2680
(77.3%). The overall inhospital mortality rate was 26.7%. Univariate analysis showed
that, in patients with definite IE, inhospital mortality was similar in patients with
positive and negative echocardiography (27.7% vs. 24.6%, respectively, p = 0.121).
In possible IE these figures were 27.5% vs. 16.7%, respectively, p < 0.001. Complications
(cardiac and extracardiac [embolic, immunological, and septic shock]) were more frequent
with positive than with negative echocardiography, regardless of clinical suspicion
(definite IE 35.5% vs. 16.8%, respectively, p < 0.001; possible IE 20.8% vs. 7.6%,
respectively, p < 0.001). Positive echocardiography was a predictor of inhospital
death by logistic regression modelling, after adjusting for confounders, definite
IE (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.02–1.76, p = 0.036), possible
IE (OR 1.59, 95% CI 1.02–2.45, p = 0.036).
Conclusions
A positive echocardiography in patients with IE is associated with increased inhospital
mortality, in addition to other clinical factors and comorbidities.
Abbreviations:
IE (infective endocarditis), IQR (interquartile range), TEE (transoesophageal echocardiography), TTE (transthoracic echocardiography)Keywords
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Article info
Publication history
Published online: February 04, 2018
Accepted:
January 31,
2018
Received in revised form:
December 14,
2017
Received:
September 26,
2017
Footnotes
☆The authors have no conflict of interest.
☆☆No funding sources.
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
