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Impact of acute heart failure in infective endocarditis: a real-world study
Session:
Sessão de Posters 44 - Endocardite Infecciosa
Speaker:
Margarida S. Cabral
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:
Margarida Cabral; Mariana Carvalho; Carolina Gonçalves; Adriana Vazão; André Martins; Catarina Ruivo; João Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Infective endocarditis (IE) is a challenging and complex disease, associated with severe complications and high mortality. The development of acute heart failure (AHF) during hospitalization has been described as a predictor of worse outcomes, however, its incidence and clinical impact are still uncertain. This study aimed to compare the clinical features, microbiological results, complications, and mortality between patients with infective endocarditis who developed AHF and those who did not.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A retrospective study was conducted and patients diagnosed with definite or possible IE (according to the modified Duke criteria) between January 2015 and March 2023 in a secondary hospital were included. The main outcomes were in-hospital and 1-year mortality. Group 1 represents patients who did not present AHF during hospitalization and group 2 includes those who did it. Group comparisons and logistic regression were performed. A p-value less than 0.05 is statistically significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Of the total 84 patients, 71.4% were male. The mean age was 67.2 years (Table 1). Fever was the main presentation feature at admission (Table 2). We counted 48 (57.1%) native valve IE, 26 prosthetic valve IE, and 8 (9.5%) device-related IE. The most common isolated microorganisms were <em>Streptococcus aureus</em> (n=16, 19.0%) and <em>Enterococcus faecalis</em> (n=11, 13.1%) (Table 3). Fifty-six patients (66.7%) developed local complications and 40 patients (47.6%) had at least a systemic complication (other than heart failure) (Table 4). Twenty-one patients (25.0%) developed AHF during hospitalization, of which eight evolved in cardiogenic shock (9.5%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In-hospital mortality was 27.4% (n=23) and 1-year mortality was 41.0% (n=34) (Table 5). In multivariate analysis, patients who suffered from AHF during hospitalization present a significantly higher risk of in-hospital mortality (HR 8.5, 95%IC [1.8;40.7], p-value<0.01) and of 1-year mortality (HR 7.6, 95%IC [2.1;28.1], p-value<0.01) independently of comorbidities, and local or systemic complications. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In conclusion, in our population, a quarter of patients with IE developed AHF during hospitalization. It has a significant impact on patients' prognosis, including both in-hospital and long-term mortality. These results suggest that we must redouble attention to patients with IE who present with signs and symptoms of heart failure upon admission.</span></span></p>
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