Abstract
Background
A retrospective study of medically treated isolated left-sided infective endocarditis
(LSIE) patients identifying predictors of outcomes with nonoperative management was
undertaken.
Methods
Medical records of 135 Manitoban medically managed LSIE patients from January 2004
to December 2016 were reviewed. Five-year survival for 135 patients and hospitalization
data till March 2016 for 65 patients were collected from the Manitoba Centre for Health
Policy.
Results
In-hospital mortality was 44%. Patients with surgical indications were more likely
to die in-hospital than those without (53% vs 24%; P = 0.002). Survival at 1 and 5 years was 43% and 23%, respectively. All-cause readmission
at 1 and 5 years was 64% and 84%, respectively. At 1 and 5 years, readmission from
major adverse events (heart failure, stroke, endocarditis) was 25% and 47%, and from
recurrent endocarditis was 17% and 26%, respectively. Severe valvular regurgitation
was a risk factor for in-hospital mortality (odds ratio, 3.52; P = 0.022), poor long-term survival (hazard ratio [HR], 2.57; P < 0.001), and recurrent endocarditis (HR, 5.93; P < 0.001). Prosthetic valve endocarditis was a risk factor for poor long-term survival
(HR, 2.11; P = 0.002). Streptococcus viridans group was associated with better rates of in-hospital mortality (odds ratio, 0.28;
P = 0.018) and long-term survival (HR, 0.34; P < 0.001).
Conclusions
Nonoperative management of LSIE carries a poor prognosis but may have a role in select
cases. Surgical management remains the mainstay for patients with clear surgical indications,
including severe regurgitation and prosthetic valve endocarditis. Further prospective
analyses are required to better delineate appropriate patient selection for nonsurgical
management.
Résumé
Introduction
Nous avons entrepris une étude rétrospective auprès de patients ayant une endocardite
infectieuse isolée du cœur gauche (EICG) traitée médicalement pour déterminer les
prédicteurs des résultats cliniques de la prise en charge non opératoire.
Méthodes
Nous avons passé en revue les dossiers médicaux de 135 patients manitobains ayant
une EICG prise en charge médicalement de janvier 2004 à décembre 2016. Nous avons
collecté les données sur la survie après 5 ans de 135 patients et les données d’hospitalisation
jusqu’en mars 2016 de 65 patients du Manitoba Centre for Health Policy.
Résultats
La mortalité intrahospitalière était de 44 %. Il était plus probable que les patients
candidats à l’intervention chirurgicale meurent à l’hôpital que les patients non-candidats
(53 % vs 24 %; P = 0,002). La survie après 1 an et la survie après 5 ans étaient respectivement de
43 % et de 23 %. La réadmission toutes causes confondues après 1 an et la réadmission
toutes causes confondues après 5 ans étaient respectivement de 64 % et de 84 %. Après
1 an et après 5 ans, la réadmission respective en raison d’événements indésirables
majeurs (insuffisance cardiaque, accident vasculaire cérébral, endocardite) était
de 25 % et de 47 %, et en raison d’une endocardite récidivante était de 17 % et de
26 %. La régurgitation valvulaire grave constituait un facteur de risque de mortalité
intrahospitalière (rapport de cotes, 3,52; P =0,022), de faible survie à long terme (rapport de risque [RR], 2,57; P < 0,001) et d’endocardite récidivante (RR, 5,93; P < 0,001). L’endocardite sur prothèse valvulaire constituait un facteur de risque
de faible survie à long terme (RR, 2,11; P = 0,002). L’endocardite à streptocoques viridans était associée à de meilleurs taux en matière de mortalité intrahospitalière (rapport
de cotes, 0,28; P = 0,018) et de survie à long terme (RR, 0,34; P < 0,001).
Conclusions
La prise en charge non opératoire de l’EICG conduit à un mauvais pronostic, mais peut
avoir un rôle à jouer dans certains cas. La prise en charge chirurgicale demeure la
pierre angulaire de la prise en charge des patients chez qui les indications opératoires
sont évidentes, notamment dans les cas de régurgitation grave et d’endocardite sur
prothèse valvulaire. D’autres analyses prospectives sont nécessaires pour procéder
à la sélection appropriée des patients à orienter vers la prise en charge non chirurgicale.
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Article info
Publication history
Published online: November 05, 2019
Accepted:
October 31,
2019
Received:
November 1,
2018
Footnotes
See page 1540 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
