SPC365

Infective Endocarditis – Sex Differences

Session: Sessão de Posters 44 - Endocardite Infecciosa
Speaker: Fernando Lima do Nascimento Ferreira

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.8 Infective Endocarditis - Other
Session Type: Cartazes
FP Number: ---
Authors: Fernando Nascimento Ferreira; Francisco Albuquerque; Rita Ilhão Moreira; Miguel Figueiredo; Julien Lopes; Barbara Teixeira; Madalena Coutinho Cruz; Ana Galrinho; Ana Teresa Timóteo; Pedro Rio; Luísa Moura Branco; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Infective Endocarditis (IE) is a pathology with significant incidence and contribution to global mortality. The impact of gender on the clinical presentation and prognosis of IE&nbsp;remains to be clarified.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong> To assess differences between sex concerning demographic, clinical, and prognostic characteristics of IE.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methodology:</strong> A retrospective study included patients with a definitive diagnosis of IE, according to the 2023 guidelines of the European Society of Cardiology (ESC), who underwent transesophageal echocardiography at a Cardiology Center of a tertiary hospital between 2015 and 2020. Two groups were defined based on sex among the IE cases, and differences in demographic, clinical, echocardiographic, therapeutic, and prognostic aspects were evaluated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 142 patients were included, 41 females (F) and 101 males (M). The average age was 66 years (&plusmn;15.6), with no differences between groups. Significant differences were observed in the prevalence of smoking and Chronic liver disease (CLD), with higher rates in M (2.4% vs. 27.5%, p=0.001; 0% vs. 12%, p=0.019 respectively). While atrial fibrillation (AF), prior mechanical valve, and endocarditis were more common in F (31.7% vs. 16.8%, p=0.049; 19.5% vs. 6.9%, p=0.049; 24.4% vs. 4%, p=0.001, respectively). Fever was the most common symptom (85.4% F vs. 95% M, p=0.078), with a higher prevalence of cardiac murmur in F (34.1% vs. 18.8%, p=0.05). The mitral valve was more affected in F (56.1% vs. 32.7%, p=0.01), with a significant difference in tricuspid valve involvement, more affected in M (0% vs. 9.9%, p=0.034). The most common echocardiographic finding in both groups was vegetation (92.7% F vs. 94.1% M, p=0.034), with a mean vegetation size of 10.35mm (&plusmn;7.7) in F and 11.17mm (&plusmn;5.6) in M (p=0.113). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">No difference was found between groups regarding the microorganism groups (p=0.298). Staphylococcus spp. was the most frequent in both groups (31.7% vs. 23.8%, p=0.038), followed by Streptococcus gallolyticus and pyogenes in F (17.1% vs 9.9%, p=0.259) and Enterococcus in M (14.9% vs 17.3%, p=0.221). Perivalvular extension was more common in F (22% vs 24.8%, p=0.723), while heart failure was more prevalent in M (14.6% vs 32.7%, OR 2.831 [1.083-7.298], p=0.029).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">51.2% of F and 55.4% of M had surgical indications (p=0.647), mainly for infection control in F (85.7% vs. 66.1%, p=0.42). Surgical intervention was performed in 24.6% of F and 26.7% of M (p=0,773). In-hospital mortality was higher in M (12.2% vs. 27.7%, p=0.47), although there was no difference in one-year mortality.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> The analysis reveals a higher prevalence of AF, mechanical valve, and prior endocarditis in F, with lower rates of smoking, and CLD. F predominantly experience mitral valve involvement and exhibit a less complicated clinical course with lower in-hospital mortality. </span></span></span></p>