Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) regist

Background/Introduction

Congestive heart failure (CHF) is a strong prognostic factor in infective endocarditis (IE), but data are lacking regarding its current management and outcome in Europe.

Purpose

To evaluate the current management and survival of patients with left-sided IE complicated by CHF.

Methods

We used data of the ESC-EORP EURO-ENDO registry, which is a prospective multicentre observational study conducted between January 1, 2016 and March 31, 2018 in 156 centres in 40 countries. The primary endpoints were 30-day and one-year mortality.

Results

Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n=698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p≤0.019). Patients with CHF experienced higher 30-day and one-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (OR [95% CI]: 2.37 [1.73–3.24]; p<0.001) and one-year mortality (HR [95% CI]: 1.69 [1.40–2.05]; p<0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n=618 [88.5%] for each group, both p<0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson index, cerebrovascular accident, staphylococcus aureus IE, Streptococcal IE, uncontrolled infection, vegetation size >10mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR [95% CI]: 0.22 [0.12–0.38]; p<0.001) and in one-year mortality (HR [95% CI]: 0.29 [0.20–0.41]; p<0.001).

Conclusion

CHF is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and one-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Abbott Vascular Int. (2011–2014) Amgen Cardiovascular (2009–2018),

Infective endocarditis in adult patients with congenital heart disease: results from the ESC EORP EURO-ENDO registry

Background

Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE)

Purpose

To characterize and to determine the prognosis of IE in this specific population.

Methods

The ESC EORP EURO-ENDO study is a prospective international study in patients (n=3111) diagnosed with IE. In this pre-specified ancillary analysis, we aimed to describe adult patients with CHD (n=365, 11·7%) and compare them with patients without CHD (non-CHD, n=2746) in terms of baseline characteristics and 1-year outcome.

Results

CHD patients (73% men, age 44·8±16·6 years) were younger and had less comorbidities. Of the CHD patients, 14% had a dental procedure in the 6 months before hospitalization versus 7% in non-CHD patients (p<0·001) and more often positive blood cultures for Streptococcus viridans (16·4% vs 8·8%, p<0·001). As in non-CHD patients, IE affected most often the left-sided valves. For CHD patients, in-hospital mortality was 9·0% vs 18·1% in non-CHD patients (p<0·001), and also 1-year outcome was more favourable (log-rank for all-cause mortality p<0·0001), even after adjustment for age (Hazard Ratio (HR) 0·61; 95% CI 0·45–0·81). Within the CHD population, multivariable Cox regression revealed the following predictors for mortality: fistula (HR 6·97), cerebral embolus (HR 4·64), renal insufficiency (HR 3·44), Staphylococcus aureus as causative agent (HR 2·06) and failure to undertake surgery when indicated (HR 5·93).

Conclusion

CHD patients with IE have better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE fuels the discussion about the need for antibiotic prophylaxis.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the program: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2021), Vifor (2019–2022). Survival CHD vs non-CHD patients

Blood polymorphism in west African breeds of sheep

This paper reports the blood groups and blood protein distribution in West African sheep breeds. About 100 animals of the Djallonke, Fulani and Touabire breeds were sampled for blood polymorphism analysis. Their blood groups were typed by haemolytic and agglutination reactions, and their blood proteins by starch gel electrophoresis. Almost all the loci analysed showed variability in the three breeds, with the Touabire and Fulani being closer to each other than to the Djallonke.

[Genetic variability of growth in sheep grown at the animal husbandry research center of Dahra]

Data on growth performances of 778 Peulpeul and Touabire sheep were collected over five years (1983-1987) in APRC of Dahra. Studied parameters were: birth weight (BBW), one month weight (MBW), weaning weight (WBW) yearling weight (YBW) and growth rate between adjacent stages of growth. BBW, MBW, WBW and YBW are: 3.6 +/- 0.6 kg, 9.5 +/- 1.8 kg; 17.5 +/- 3.5 kg; 30.6 +/- 4.3 kg. Growth rates were 197.0 +/- 51.2 g between birth and one month (MGR), 87.2 +/- 28.1 g, between one month and weaning (WGR) and 50.8 +/- 15.3 g, between weaning and yearling (YGR). Year and season of birth, dam parity, prolificity, sex and race had significant effect on most of the parameters studied. The heritability estimates were 0.50 +/- 0.14 (BBW), 0.52 +/- 0.15 (MBW), 0.71 +/- 0.18 (WBW), 0.44 +/- 0.13 (MGR) and 0.60 +/- 0.16 (WGR). High and positive correlations existed between BBW and the other growth components.