What are the therapeutic and prognostic concerns regarding patients with valvular involvement in infective endocarditis?

Factors affecting prognosis for patients with infective endocarditis

Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009 Mar 9;169(5):463-73.

Cohort study (N=2,781) of adults with definite infective endocarditis (modified Duke criteria) enrolled 06/2000 – 09/2005 at medical centers around the world. Tables summarize clinical and lab findings, as well as microbiologic etiology. Table 7 presents data on factors associated with in-hospital mortality. Pertinent to the case presented in the report, the adjusted odds ratio for in-hospital mortality was
♦1.34 (95% CI, 1.06-1.68; p=0.01) in patients with mitral valve vegetation
♦1.30 (95% CI, 1.17-1.46; p<0.001) for age (in 10 year intervals; mean age of the cohort=56.5)

Indications for surgery in patients with involvement of native valve endocarditis (NVE)

2014 ACC/AHA guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. States “Most of the indications for surgical intervention are the same for NVE and PVE and are included in 1 recommendation for both when possible.” Class IIb recommendation within 12.2.3 Intervention section states, “Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) may be considered in patients with NVE who exhibit mobile vegetations greater than 10 mm in length (with or without clinical evidence of embolic phenomenon). (Level of Evidence: B)”

Table 3. Echocardiographic Features That Suggest Potential Need for Surgical Intervention IN Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005 Jun 14;111(23):e394-434.

Updated 2/23/2016 ldt


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Clinical Informationist at EUH Branch Library
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