SPC365

Infective Endocarditis and Acute Heart Failure: A Cohort Analysis of Risk Factors and Mortality

Session: SESSÃO DE POSTERS 12 - ENDOCARDITE INFECIOSA 1
Speaker: Liliana Brochado

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Liliana Brochado; Diogo Cunha; Mariana Martinho; Bárbara Ferreira; Oliveira Baltazar; João Luz; Nazar Ilchyshyn; Adriana Silva; Hélder Pereira; Paula Fazendas

<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Acute heart failure (AHF) is the most frequent complication of infective endocarditis (IE) and the leading indication for urgent/emergent heart surgery. Patients with IE and acute onset of symptoms are at high risk of mortality. </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Still, the</span></span> <span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">characteristics associated with AHF in those with IE are poorly defined. </span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Purpose:</span></span></strong> <span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">To characterize a cohort of IE patients, identify risk factors for AHF within this group, and evaluate its impact on mortality.</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> We conducted a retrospective, single-center analysis of patients hospitalized with IE (2006-2021). We assessed </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">in-hospital mortality and </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">all causes of mortality over a 1-year follow-up period. </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Logistic regression and Cox regression analyses were performed to identify risk factors for developing HF and <span style="color:black">t</span>he </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">mortality predictors.</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Among 221 EI patients, 79 (35,7%) had acute heart failure (AHF), </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">but only 38% of these patients underwent surgical intervention</span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">. Patients with AHF demonstrated significantly higher rates of in-hospital mortality compared to those without AHF (39.2% vs. 22.1%; p=0.008), as well as increased 1-year mortality (57.0% vs. 33.1%; p&lt;0.001).&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">The main characteristics among patients who developed AHF in the context of IE included being male (81% vs. 66.9%; p=0.029), pre-existing valvular heart disease (57% vs. 36.9%; p=0.005), coronary artery disease (20.3% vs. 6.3%; p=0.003), and a history of heart failure (38.0% vs. 14.8%; p&lt;0.001). Additionally, these patients more frequently presented with constitutional symptoms (66.2% vs. 42.2%; p=0.002), involvement of the aortic valve (65.8% vs. 48.2%; p=0.016), and a history of invasive procedures in the past 3 months (47.8% vs. 20.8%; p&lt;0.001). Among local complications of IE, progression to regurgitation was the sole differentiating factor associated with AHF development (75% vs. 50%; p&lt;0.001). The presence of valvular heart disease (OR 2.54; 95% CI 1.28&ndash;5.05; p=0.008), coronary artery disease (OR 4.49; 95% CI 1.56&ndash;12.96; p=0.005), recent invasive procedures within the past 3 months (OR 2.41; 95% CI 1.19&ndash;4.91; p=0.015), and constitutional symptoms at admission (OR 3.23; 95% CI 1.59&ndash;6.52; p&lt;0.001) were independently associated with an increased likelihood of developing AHF. Multivariable analysis identified AHF, alongside septic shock, as a significant predictor of mortality (HR 1.86; 95% CI 1.236&ndash;2.822; p&lt;0.001).</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Our study demonstrated a high rate of in-hospital and one-year mortality among patients with IE who developed AHF, associated with a low rate of cardiac surgeries performed. These findings emphasize the critical need for timely and effective management strategies. By identifying patient characteristics associated with an increased risk of AHF, earlier surgical referral and intervention could be facilitated, potentially leading to significantly improved clinical outcomes.</span></span></p>