Risk Factors for Acute Heart Failure in Patients with Infective Endocarditis
Abstract
Background. Acute heart failure (AHF) in patients with infective endocarditis (IE) is an independent indication for urgent cardiac surgery according to international guidelines. Preoperative risk factors for AHF in patients with IE empower to build the route of a patient rationally according to clinical status.
The aim. To analyze clinically significant risk factors for AHF in patients with IE.
Materials and methods. A retrospective single-center study was conducted which included clinical data of 311 patients with IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from January 1, 2019 to October 22, 2021. The mean age of the patients was 47.9 ± 3.83 (19 to 77) years. The proportion of men in the study was 81.7% (254 patients). The mean duration of IE was 2.6 ± 0.1 (1 to 11) months. Global database for IE patients was divided into separate cohorts with different problems associated with this pathology. Diagnosis of IE was established according to the Duke criteria. The causative agent was identified and results of antibioticogram were evaluated. All the patients were divided into classes according to the New York Heart Association (NYHA) functional scale. Patients with signs of AHF were assigned to NYHA class IV. There were 2 groups of patients: 252 (81.1%) patients without signs of AHF before surgery, 59 (18.9%) patients with preoperative AHF. The risk factors for the occurrence of AHF were analyzed. Statistical significance was set at p < 0.05. The intensive care unit length of stay and hospital length of stay were evaluated.
Results. Risk factors for preoperative AHF in patients with IE: IE of the aortic valve (odds ratio (OR), 2.97 [1.57-6.91]) (p=0.003); concomitant inflammatory pathology of the lungs (OR 3.37 [1.55-7.11]) (р=0.003); linezolid resistance of the pathogen (OR 2.34 [1.07-4.26]) (р=0.026); vancomycin resistance of the pathogen (OR 2.25 [1.13-4.74]) (p=0.032); IE of the prosthetic heart valve (OR 1.155 [1.01-1.1]) (p=0.036); nosocomial nature of the disease (OR 2.14 [0.83-4.37]) (р=0.049). The intensive care unit length of stay was significantly longer in the group of patients with AHF (8.8 ± 0.7 days) than in the group of patients without AHF (4.8 ± 0.2 days) (р˂0.001). For 311 surgical interventions, the number of deaths was 7 (2.3%). The analysis of deaths according to the type of complications revealed that 4 (1.5%) patients died due to cardiac causes (263 cardiac complications). Among them, the largest share was made up of patients with AHF: 3 (1.4%).
Conclusions. In clinical work, it is important to identify preoperative factors that are associated with the tactics of treatment of patients with IE in order to improve the results of cardiac surgery.
References
- Agrawal A, Virk HUH, Riaz I, Jain D, Tripathi B, Krittanawong C, et al. Predictors of 30-day re-admissions in patients with infective endocarditis: a national population based cohort study. Rev Cardiovasc Med. 2020;21(1):123-127. https://doi.org/10.31083/j.rcm.2020.01.552
- Pericàs JM, Hernández-Meneses M, Muñoz P, Martínez-Sellés M, Álvarez-Uria A, de Alarcón A, et al.; Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES). Characteristics and Outcome of Acute Heart Failure in Infective Endocarditis: Focus on Cardiogenic Shock. Clin Infect Dis. 2021;73(5):765-774. https://doi.org/10.1093/cid/ciab098
- Mir T, Uddin M, Qureshi WT, Regmi N, Tleyjeh IM, Saydain G. Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016-2018). Infect Dis Ther. 2022;11(1):305-321. https://doi.org/10.1007/s40121-021-00563-y
- Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, et al.; EURO-ENDO Investigators. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40(39):3222-3232. https://doi.org/10.1093/eurheartj/ehz620
- Matsuura R, Yoshioka D, Toda K, Yokoyama J, Miyagawa S, Yoshikawa Y, et al.; Osaka Cardiovascular Research (OSCAR) Study Group. Effect of the Initial Strategy for Active Endocarditis Complicated With Acute Heart Failure. Circ J. 2018;82(11):2896-2904. https://doi.org/10.1253/circj.CJ-18-0510
- Hermanns H, Eberl S, Terwindt LE, Mastenbroek TCB, Bauer WO, van der Vaart TW, et al. Anesthesia Considerations in Infective Endocarditis. Anesthesiology. 2022;136(4):633-656. https://doi.org/10.1097/ALN.0000000000004130
- Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al.; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435-1486. https://doi.org/10.1161/CIR.0000000000000296. Erratum in: Circulation. 2015 Oct 27;132(17):e215. Erratum in: Circulation. 2016 Aug 23;134(8):e113. Erratum in: Circulation. 2018 Jul 31;138(5):e78-e79.
- Nakatani S, Ohara T, Ashihara K, Izumi C, Iwanaga S, Eishi K, et al.; Japanese Circulation Society Joint Working Group. JCS 2017 Guideline on Prevention and Treatment of Infective Endocarditis. Circ J. 2019;83(8):1767-1809. https://doi.org/10.1253/circj.CJ-19-0549
- Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e227. https://doi.org/10.1161/CIR.0000000000000923. Erratum in: Circulation. 2021 Feb 2;143(5):e229. Erratum in: Circulation. 2023 Aug 22;148(8):e8.
- AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs; Pettersson GB, Coselli JS; Writing Committee; Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg. 2017;153(6):1241-1258.e29. https://doi.org/10.1016/j.jtcvs.2016.09.093
- Pettersson GB, Hussain ST. Current AATS guidelines on surgical treatment of infective endocarditis. Ann Cardiothorac Surg. 2019;8(6):630-644. https://doi.org/10.21037/acs.2019.10.05
- Jamil M, Sultan I, Gleason TG, Navid F, Fallert MA, Suffoletto MS, et al. Infective endocarditis: trends, surgical outcomes, and controversies. J Thorac Dis. 2019;11(11):4875-4885. https://doi.org/10.21037/jtd.2019.10.45
- Kang DH, Kim YJ, Kim SH, Sun BJ, Kim DH, Yun SC, et al. Early Surgery versus Conventional Treatment for Infective Endocarditis. N Engl J Med. 2012;366(26):2466-2473. https://doi.org/10.1056/NEJMoa1112843
- Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, et al. Challenges in Infective Endocarditis. J Am Coll Cardiol. 2017;69(3):325-344. https://doi.org/10.1016/j.jacc.2016.10.066
- Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA Intern Med. 2017;177(9):1308-1315. https://doi.org/10.1001/jamainternmed.2017.1938
- Arulkumaran N, Routledge M, Schlebusch S, Lipman J, Conway Morris A. Antimicrobial-associated harm in critical care: a narrative review. Intensive Care Med. 2020;46(2):225-235. https://doi.org/10.1007/s00134-020-05929-3
