Infective endocarditis in adult patients with congenital heart disease.
van Melle JP, Roos-Hesselink JW, Bansal M, Kamp O, Meshaal M, Pudich J, Luksic VR, Rodriguez-Alvarez R, Sadeghpour A, Hanzevacki JS, Sow R, Timóteo AT, Morgado MT, De Bonis M, Laroche C, Boersma E, Lancellotti P, Habib G; EURO-ENDO Investigators Group.
Int J Cardiol. 2023 Jan 1;370:178-185. doi: 10.1016/j.ijcard.2022.10.136. Epub 2022 Oct 21.
PMID: 36273665
Take-Home Points:
- Patients with congenital heart disease (CHD) who develop infective endocarditis (IE) present at a younger age and have fewer comorbidities compared to non-CHD patients.
- Aortic valve-related problems, including bicuspid valves, are commonly observed in CHD patients with IE.
- Delays in seeking medical care are more common in CHD patients, highlighting the importance of early diagnosis and prompt treatment.
- Blood cultures may be less frequently positive in CHD patients with IE, and the causative agents differ from those in non-CHD patients.
- CHD patients with IE more commonly exhibit involvement of the aortic or pulmonary valves, while mitral and tricuspid valve involvement is more prevalent in non-CHD patients.
- Antimicrobial therapy is the mainstay treatment, but CHD patients may require surgical interventions more frequently.
- CHD patients with IE have lower in-hospital and one-year all-cause mortality rates compared to non-CHD patients.
- Factors associated with higher mortality in CHD patients include the presence of a fistula, cerebral complications, renal insufficiency, Staphylococcus aureus as the causative agent, and not undergoing surgery when indicated.
- These findings emphasize the need for early diagnosis, prompt treatment, and consideration of surgical interventions in CHD patients with IE to improve outcomes.
Commentary from Dr. Pradeepkumar Charla (Rochester, USA), section editor of ACHD Journal Watch
The article “Infective endocarditis in adult patients with congenital heart disease” by Joost P van Melle et al. is a retrospective analysis of data from the ESC-EORP-EURO-ENDO registry, which is a prospective international study of patients with infective endocarditis (IE). The authors analyzed 365 adult patients with congenital heart disease (CHD).
Strengths of the study:
The authors did an excellent job controlling for potential confounders, such as age, gender, and comorbidity burden. This makes their findings more reliable.
- The study was conducted in a large, international cohort of patients, which gives the findings more generalizability.
- The study was conducted over a long period (The median follow-up 700 days), allowing for a more comprehensive assessment of long-term outcomes.
Study Highlights:
- The study investigated infective endocarditis (IE) in patients with congenital heart disease (CHD) and compared them to non-CHD patients.
- CHD patients with IE were younger and had fewer cardiovascular and non-cardiac comorbidities compared to non-CHD patients.
- The most common risk factors for IE in CHD patients were dental procedures and prosthetic heart valves.
- The most common pathogens in CHD patients were Streptococcus viridans and Staphylococcus aureus.
- Aortic valve-related problems, including bicuspid valves, were the most common in CHD patients with IE.
- CHD patients had a longer time between symptom onset and hospital admission, potentially indicating delays in seeking medical care.
- Blood cultures were less often positive in CHD patients, and the causative agents differed between CHD and non-CHD patients.
- CHD patients more commonly had involvement of the aortic or pulmonary valves, while non-CHD patients had a higher prevalence of mitral and tricuspid valve involvement.
- Antimicrobial therapy was the mainstay treatment, but surgical interventions were more frequently performed in the CHD group.
- CHD patients had lower in-hospital and one-year all-cause mortality rates compared to non-CHD patients (9.0% vs 18.1%). They also had a better long-term survival rate (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities.
- The most common complications of IE in CHD patients were heart failure and stroke.
- Factors associated with higher all-cause mortality in the CHD group included the presence of a fistula, cerebral complications, renal insufficiency, Staphylococcus aureus as the causative agent, and not undergoing surgery when indicated.
