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, Steven 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, Vance Fowler Jr, Anna Lisa Crowley

Research output: Contribution to journalArticleResearchpeer-review

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
Article numbere003397
Pages (from-to)1-10
Number of pages10
JournalCirculation. Cardiovascular imaging
Volume8
Issue number7
DOIs
Publication statusPublished - 10 Jul 2015

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Endocarditis
Abscess
Staphylococcus aureus
Cohort Studies
Mortality
Confidence Intervals
Hospital Mortality
Proportional Hazards Models
Stroke Volume
Survival Rate
Odds Ratio
Survival

Cite this

Lauridsen, Trine K. ; Tong, Steven ; Selton-Suty, Christine ; Peterson, Gail ; Cecchi, Enrico ; Afonso, Luis ; Habib, Gilbert ; Paré, Carlos ; Tamin, Syahidah ; Dickerman, Stuart ; Bayer, Arnold S. ; Johansson, Magnus C. ; Chu, Vivian H. ; Fowler Jr, Vance ; Crowley, Anna Lisa. / 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. In: Circulation. Cardiovascular imaging. 2015 ; Vol. 8, No. 7. pp. 1-10.
@article{86ac09f864884bc88416c574da537396,
title = "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",
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. ",
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author = "Lauridsen, {Trine K.} and Steven Tong and Christine Selton-Suty and Gail Peterson and Enrico Cecchi and Luis Afonso and Gilbert Habib and Carlos Par{\'e} and Syahidah Tamin and Stuart Dickerman and Bayer, {Arnold S.} and Johansson, {Magnus C.} and Chu, {Vivian H.} and {Fowler Jr}, Vance and Crowley, {Anna Lisa}",
year = "2015",
month = "7",
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doi = "10.1161/CIRCIMAGING.114.003397",
language = "English",
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pages = "1--10",
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issn = "1941-9651",
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Lauridsen, TK, Tong, S, Selton-Suty, C, Peterson, G, Cecchi, E, Afonso, L, Habib, G, Paré, C, Tamin, S, Dickerman, S, Bayer, AS, Johansson, MC, Chu, VH, Fowler Jr, V & Crowley, AL 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, vol. 8, no. 7, e003397, pp. 1-10. https://doi.org/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. / Lauridsen, Trine K.; Tong, Steven; Selton-Suty, Christine; Peterson, Gail; Cecchi, Enrico; Afonso, Luis; Habib, Gilbert; Paré, Carlos; Tamin, Syahidah; Dickerman, Stuart; Bayer, Arnold S.; Johansson, Magnus C.; Chu, Vivian H.; Fowler Jr, Vance; Crowley, Anna Lisa.

In: Circulation. Cardiovascular imaging, Vol. 8, No. 7, e003397, 10.07.2015, p. 1-10.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Echocardiographic Findings Predict In-Hospital and 1 Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis

T2 - Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study

AU - Lauridsen, Trine K.

AU - Tong, Steven

AU - Selton-Suty, Christine

AU - Peterson, Gail

AU - Cecchi, Enrico

AU - Afonso, Luis

AU - Habib, Gilbert

AU - Paré, Carlos

AU - Tamin, Syahidah

AU - Dickerman, Stuart

AU - Bayer, Arnold S.

AU - Johansson, Magnus C.

AU - Chu, Vivian H.

AU - Fowler Jr, Vance

AU - Crowley, Anna Lisa

PY - 2015/7/10

Y1 - 2015/7/10

N2 - 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. 

AB - 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. 

KW - adult

KW - aged

KW - aorta stenosis

KW - aorta valve regurgitation

KW - Article

KW - bacterial endocarditis

KW - cardiovascular mortality

KW - cohort analysis

KW - echocardiography

KW - female

KW - follow up

KW - heart abscess

KW - heart left ventricle ejection fraction

KW - human

KW - left sided native valve infective endocarditis

KW - major clinical study

KW - male

KW - mitral valve regurgitation

KW - mitral valve stenosis

KW - multicenter study

KW - nonhuman

KW - priority journal

KW - propensity score

KW - prospective study

KW - Staphylococcus aureus

KW - Staphylococcus infection

KW - survival rate

KW - abscess

KW - case control study

KW - clinical trial

KW - cooperation

KW - echography

KW - heart left ventricle function

KW - heart stroke volume

KW - international cooperation

KW - Kaplan Meier method

KW - microbiology

KW - middle aged

KW - mortality

KW - multivariate analysis

KW - odds ratio

KW - pathophysiology

KW - predictive value

KW - prognosis

KW - proportional hazards model

KW - register

KW - risk assessment

KW - risk factor

KW - statistical model

KW - transesophageal echocardiography

KW - Abscess

KW - Adult

KW - Aged

KW - Case-Control Studies

KW - Cooperative Behavior

KW - Echocardiography, Transesophageal

KW - Endocarditis, Bacterial

KW - Female

KW - Hospital Mortality

KW - Humans

KW - International Cooperation

KW - Kaplan-Meier Estimate

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Odds Ratio

KW - Predictive Value of Tests

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Staphylococcal Infections

KW - Stroke Volume

KW - Ventricular Function, Left

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U2 - 10.1161/CIRCIMAGING.114.003397

DO - 10.1161/CIRCIMAGING.114.003397

M3 - Article

VL - 8

SP - 1

EP - 10

JO - Circulation. Cardiovascular imaging

JF - Circulation. Cardiovascular imaging

SN - 1941-9651

IS - 7

M1 - e003397

ER -