Infective endocarditis in adult patients with congenital heart disease

Joost P. van Melle; Jolien W. Roos-Hesselink; on behalf of the EURO-ENDO Investigators Group; Manish Bansal; Otto Kamp; Marwa Meshaal; Jiri Pudich; Vlatka Reskovic Luksic; Regino Rodriguez-Alvarez; Anita Sadeghpour; Jadranka Separovic Hanzevacki; Rouguiatou Sow; Ana Teresa Timóteo; Marisa Trabulo Morgado; Michele De Bonis; Cecile Laroche; Eric Boersma; Patrizio Lancellotti; Gilbert Habib

doi:10.1016/j.ijcard.2022.10.136

Infective endocarditis in adult patients with congenital heart disease

Joost P. van Melle^*, Jolien W. Roos-Hesselink, on behalf of the EURO-ENDO Investigators Group, Manish Bansal, Otto Kamp, Marwa Meshaal, Jiri Pudich, Vlatka Reskovic Luksic, Regino Rodriguez-Alvarez, Anita Sadeghpour, Jadranka Separovic Hanzevacki, Rouguiatou Sow, Ana Teresa Timóteo, Marisa Trabulo Morgado, Michele De Bonis, Cecile Laroche, Eric Boersma, Patrizio Lancellotti, Gilbert Habib

^*Corresponding author for this work

Cardiology

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Abstract

Background: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. Methods: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. Results: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50–0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36–14.47]), cerebral embolus (HR 4.64 [2.08–10.35]), renal insufficiency (HR 3.44 [1.48–8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11–3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15–11.18]). Conclusions: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

Original language	English
Pages (from-to)	178-185
Number of pages	8
Journal	International Journal of Cardiology
Volume	370
DOIs	https://doi.org/10.1016/j.ijcard.2022.10.136
Publication status	Published - 1 Jan 2023

Bibliographical note

Funding Information:
This work was supported by Abbott Vascular Int . (2011−2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011−2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc . (2014–2016), Menarini Int. Op . (2009–2012), MSD-Merck & Co . (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), Vifor (2019–2022).

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van Melle, J. P., Roos-Hesselink, J. W., on behalf of the EURO-ENDO Investigators Group, Bansal, M., Kamp, O., Meshaal, M., Pudich, J., Luksic, V. R., Rodriguez-Alvarez, R., Sadeghpour, A., Hanzevacki, J. S., Sow, R., Timóteo, A. T., Morgado, M. T., De Bonis, M., Laroche, C., Boersma, E., Lancellotti, P., & Habib, G. (2023). Infective endocarditis in adult patients with congenital heart disease. International Journal of Cardiology, 370, 178-185. https://doi.org/10.1016/j.ijcard.2022.10.136

@article{b9b85d83d41f4082bc0e0dc53ff9969f,

title = "Infective endocarditis in adult patients with congenital heart disease",

abstract = "Background: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. Methods: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. Results: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50–0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36–14.47]), cerebral embolus (HR 4.64 [2.08–10.35]), renal insufficiency (HR 3.44 [1.48–8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11–3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15–11.18]). Conclusions: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.",

author = "{van Melle}, {Joost P.} and Roos-Hesselink, {Jolien W.} and {on behalf of the EURO-ENDO Investigators Group} and Manish Bansal and Otto Kamp and Marwa Meshaal and Jiri Pudich and Luksic, {Vlatka Reskovic} and Regino Rodriguez-Alvarez and Anita Sadeghpour and Hanzevacki, {Jadranka Separovic} and Rouguiatou Sow and Tim{\'o}teo, {Ana Teresa} and Morgado, {Marisa Trabulo} and {De Bonis}, Michele and Cecile Laroche and Eric Boersma and Patrizio Lancellotti and Gilbert Habib",

note = "Funding Information: This work was supported by Abbott Vascular Int . (2011−2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011−2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc . (2014–2016), Menarini Int. Op . (2009–2012), MSD-Merck & Co . (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), Vifor (2019–2022). Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2023",

month = jan,

day = "1",

doi = "10.1016/j.ijcard.2022.10.136",

language = "English",

volume = "370",

pages = "178--185",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

van Melle, JP, Roos-Hesselink, JW, on behalf of the EURO-ENDO Investigators Group, Bansal, M, Kamp, O, Meshaal, M, Pudich, J, Luksic, VR, Rodriguez-Alvarez, R, Sadeghpour, A, Hanzevacki, JS, Sow, R, Timóteo, AT, Morgado, MT, De Bonis, M, Laroche, C, Boersma, E, Lancellotti, P & Habib, G 2023, 'Infective endocarditis in adult patients with congenital heart disease', International Journal of Cardiology, vol. 370, pp. 178-185. https://doi.org/10.1016/j.ijcard.2022.10.136

TY - JOUR

T1 - Infective endocarditis in adult patients with congenital heart disease

AU - van Melle, Joost P.

AU - Roos-Hesselink, Jolien W.

AU - on behalf of the EURO-ENDO Investigators Group

AU - Bansal, Manish

AU - Kamp, Otto

AU - Meshaal, Marwa

AU - Pudich, Jiri

AU - Luksic, Vlatka Reskovic

AU - Rodriguez-Alvarez, Regino

AU - Sadeghpour, Anita

AU - Hanzevacki, Jadranka Separovic

AU - Sow, Rouguiatou

AU - Timóteo, Ana Teresa

AU - Morgado, Marisa Trabulo

AU - De Bonis, Michele

AU - Laroche, Cecile

AU - Boersma, Eric

AU - Lancellotti, Patrizio

AU - Habib, Gilbert

N1 - Funding Information: This work was supported by Abbott Vascular Int . (2011−2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011−2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc . (2014–2016), Menarini Int. Op . (2009–2012), MSD-Merck & Co . (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), Vifor (2019–2022). Publisher Copyright: © 2022 The Author(s)

PY - 2023/1/1

Y1 - 2023/1/1

N2 - Background: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. Methods: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. Results: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50–0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36–14.47]), cerebral embolus (HR 4.64 [2.08–10.35]), renal insufficiency (HR 3.44 [1.48–8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11–3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15–11.18]). Conclusions: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

AB - Background: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. Methods: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. Results: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50–0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36–14.47]), cerebral embolus (HR 4.64 [2.08–10.35]), renal insufficiency (HR 3.44 [1.48–8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11–3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15–11.18]). Conclusions: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

UR - http://www.scopus.com/inward/record.url?scp=85140449385&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2022.10.136

DO - 10.1016/j.ijcard.2022.10.136

M3 - Article

C2 - 36273665

AN - SCOPUS:85140449385

SN - 0167-5273

VL - 370

SP - 178

EP - 185

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Infective endocarditis in adult patients with congenital heart disease

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