Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study

Trine K Lauridsen; Lawrence Park; Steven Y C Tong; Christine Selton-Suty; Gail Peterson; Enrico Cecchi; Luis Afonso; Gilbert Habib; Carlos Paré; Syahidah Tamin; Stuart Dickerman; Arnold S Bayer; Magnus C Johansson; Vivian H Chu; Zainab Samad; Niels E Bruun; Vance G Fowler Jr; Anna Lisa Crowley

doi:10.1161/CIRCIMAGING.114.003397

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study

Circ Cardiovasc Imaging. 2015 Jul;8(7):e003397. doi: 10.1161/CIRCIMAGING.114.003397.

Authors

Trine K Lauridsen¹, Lawrence Park¹, Steven Y C Tong¹, Christine Selton-Suty¹, Gail Peterson¹, Enrico Cecchi¹, Luis Afonso¹, Gilbert Habib¹, Carlos Paré¹, Syahidah Tamin¹, Stuart Dickerman¹, Arnold S Bayer¹, Magnus C Johansson¹, Vivian H Chu¹, Zainab Samad¹, Niels E Bruun¹, Vance G Fowler Jr¹, Anna Lisa Crowley²

Affiliations

¹ From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.).
² From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.). annalisa.crowley@duke.edu.

Abstract

Background: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown.

Methods and results: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality.

Conclusions: S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.

Keywords: echocardiography; endocarditis; odds ratio; risk factors; survival analysis.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Abscess / diagnostic imaging*
Abscess / microbiology
Abscess / mortality*
Abscess / physiopathology
Adult
Aged
Case-Control Studies
Cooperative Behavior
Echocardiography, Transesophageal*
Endocarditis, Bacterial / diagnostic imaging*
Endocarditis, Bacterial / microbiology
Endocarditis, Bacterial / mortality*
Endocarditis, Bacterial / physiopathology
Female
Hospital Mortality*
Humans
International Cooperation
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Risk Factors
Staphylococcal Infections / diagnostic imaging*
Staphylococcal Infections / microbiology
Staphylococcal Infections / mortality*
Staphylococcal Infections / physiopathology
Stroke Volume
Ventricular Function, Left

Abstract

Publication types

MeSH terms

Grants and funding