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. ",
    keywords = "adult, aged, aorta stenosis, aorta valve regurgitation, Article, bacterial endocarditis, cardiovascular mortality, cohort analysis, echocardiography, female, follow up, heart abscess, heart left ventricle ejection fraction, human, left sided native valve infective endocarditis, major clinical study, male, mitral valve regurgitation, mitral valve stenosis, multicenter study, nonhuman, priority journal, propensity score, prospective study, Staphylococcus aureus, Staphylococcus infection, survival rate, abscess, case control study, clinical trial, cooperation, echography, heart left ventricle function, heart stroke volume, international cooperation, Kaplan Meier method, microbiology, middle aged, mortality, multivariate analysis, odds ratio, pathophysiology, predictive value, prognosis, proportional hazards model, register, risk assessment, risk factor, statistical model, transesophageal echocardiography, Abscess, Adult, Aged, Case-Control Studies, Cooperative Behavior, Echocardiography, Transesophageal, Endocarditis, Bacterial, 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, Stroke Volume, Ventricular Function, Left",
    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",
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    doi = "10.1161/CIRCIMAGING.114.003397",
    language = "English",
    volume = "8",
    pages = "1--10",
    journal = "Circulation. Cardiovascular imaging",
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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

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    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

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    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

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    VL - 8

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    EP - 10

    JO - Circulation. Cardiovascular imaging

    JF - Circulation. Cardiovascular imaging

    SN - 1941-9651

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