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, Anna Lisa Crowley

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22 Scopus citations

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.

Original languageEnglish (US)
Article numbere003397
JournalCirculation: Cardiovascular Imaging
Volume8
Issue number7
DOIs
StatePublished - May 1 2015

Keywords

  • Echocardiography
  • Endocarditis
  • Odds ratio
  • Risk factors
  • Survival analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Lauridsen, T. K., Park, L., Tong, S. Y. C., Selton-Suty, C., Peterson, G., Cecchi, E., Afonso, L., Habib, G., Paré, C., Tamin, S., Dickerman, S., Bayer, A. S., Johansson, M. C., Chu, V. H., Samad, Z., Bruun, N. E., Fowler, V. G., & Crowley, A. L. (2015). 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. Circulation: Cardiovascular Imaging, 8(7), [e003397]. https://doi.org/10.1161/CIRCIMAGING.114.003397