Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital

Authors

  • N. Fernández-Hidalgo,

    1.  Department of Infectious Diseases, Hospital Universitari Vall d’Hebron
    2.  Department of Medicine, Universitat Autònoma de Barcelona
    3.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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  • B. Almirante,

    1.  Department of Infectious Diseases, Hospital Universitari Vall d’Hebron
    2.  Department of Medicine, Universitat Autònoma de Barcelona
    3.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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  • P. Tornos,

    1.  Department of Medicine, Universitat Autònoma de Barcelona
    2.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
    3.  Department of Cardiology, Hospital Universitari Vall d’Hebron
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  • M. T. González-Alujas,

    1.  Department of Medicine, Universitat Autònoma de Barcelona
    2.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
    3.  Department of Cardiology, Hospital Universitari Vall d’Hebron
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  • A. M. Planes,

    1.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
    2.  Department of Microbiology, Hospital Universitari Vall d’Hebron
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  • M. Galiñanes,

    1.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
    2.  Department of Cardiac Surgery, Hospital Universitari Vall d’Hebron
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  • A. Pahissa

    1.  Department of Infectious Diseases, Hospital Universitari Vall d’Hebron
    2.  Department of Medicine, Universitat Autònoma de Barcelona
    3.  Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Corresponding author: N. Fernández-Hidalgo, Servei de Malalties Infeccioses, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
E-mail: nufernan@gmail.com

Abstract

Clin Microbiol Infect 2012; 18: E522–E530

Abstract

The aim of this study was to describe the immediate and long-term prognosis of a contemporary cohort of patients with left-sided infective endocarditis (LSIE). A prospective observational cohort study was conducted in a referral centre. Between January 2000 and December 2011, all consecutive adult patients with LSIE were followed-up until death, relapse, recurrence, need for late surgery, or last control. During the active phase of IE, 174 of 438 patients underwent surgery (40% overall; 43% native valve (NVIE), 30% prosthetic valve (PVIE)) and 125 died (29% overall; 26% NVIE, 39% PVIE). The median follow-up in survivors was 3.2 years (interquartile range (IQR) 1.0–6.0 years). Relapses occurred in seven patients (2.2%; 95% CI, 1.1–4.5) and recurrences in eight (2.6%; 95% CI, 1.3–5.0), with an incidence density of 0.0067 per patient-year (95% CI, 0.0029–0.0133) and high mortality (75% of recurrences). Only four of 130 survivors (3.1%; 95% CI, 1.2–7.6) who were treated surgically during the active phase of the disease, and 14/183 (7.7%; 95% CI, 4.6–12.4) of those not undergoing surgery needed operation during follow-up (p 0.09). In the 313 survivors, actuarial survival was 86% at 1 year (87% NVIE, 83% PVIE), 79% at 2 years (81% NVIE, 72% PVIE) and 68% at 5 years (71% NVIE, 57% PVIE). At 1 year, 115 of 397 patients (29.0%; 95% CI, 24.7–33.6) remained alive, with no surgery requirement, relapse or recurrence. LSIE is associated with considerable in-hospital and long-term mortality, especially PVIE. However, relapses, recurrences and the need for late surgery are uncommon.

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