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Heart failure class at presentation: a predictor of prognosis in patients with infective endocarditis
R Santos B1
1Hospital Center of Porto, Cardiology - Porto - Portugal
European Journal of Heart Failure Abstracts Supplement
Purpose: Despite diagnostic and
therapeutic advances infective endocarditis remains an important cause of morbidity and mortality worldwide. To recognise predictors of poor prognosis at presentation is crucial in the management of these patients. Methods: Retrospective, single center study, of patients admitted for infective endocarditis (EI) in a tertiary hospital, during a ten years period. The patients were divided in two groups according to heart failure classification by New York Heart Association (NYHA) criterions at admission: Group 1 (NYHA class I/II) and Group 2 (NYHA class III/IV). For each group we analyse clinical, echocardiographic parameters and in-hospital and one year outcomes. Results: 103 patients with EI were included, 62,1% men, mean age 65,8 ± 17,2 years. Native valve EI was present in 85% of cases with same prevalence of aortic and mitral valve involvement (40%). Perivalvular complication were reported in 17,6% (14,7% abscess and 2,9% fistulas). According to division in heart failure NYHA class at presentation Group 1 included 72 patients and Group 2 31 patients. There were no significant differences between groups regarding gender, type and location of EI or perivalvular complication, but with a higher proportion of severe valvular regurgitation in Group 2 (18,3 vs 28,7% p = 0.027). Patients in Group 2 were older (62,6 ± 17,1 vs 73,2 ± 15,1 years p = 0.003), had a lower creatinine clearance at admission (68,1 ± 29,4 vs 44,6 ± 23,9 p < 0.001) and developed more frequent acute kidney injury ( 25,4 vs 51,6% p = 0.010), with no significant differences in diabetes, immunosuppression or use of IV drugs. Group 2 had also a higher percentage of patients with atrial fibrillation (28,2% vs 44,8% p=0,010) and with moderate to severe left ventricular dysfunction (4,3% vs 20% p=0,020). We found same proportion of embolic events, but with higher rates of sepsis and cardiogenic shock in Group 2. In-hospital and one year mortality rate were higher in Group 2 (21,4% vs 45,2% p = 0.015 and 6,0% vs 28,6% p = 0.036, respectively). After multivariate analysis acute kidney injury and NYHA class remained as independent predictors of mortality (OR: 3,44; 95% CI: 1,22 to 9,66; p = 0.019 and OR:2,37; 95% CI:0,72 to 7,83; p = 0.043). Conclusion: NYHA class at admission proved to be a strong predictor of prognosis in patients with EI. Presentation in class III/IV NYHA reflects a type of patients with higher comorbidities and in-hospital complications, with a consequent higher mortality rates.
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