P971Infective endocarditis (IE) in the context of time: summary of 17 years


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Abstract

371 (308 + 63) IE cases of the National Health Center (1992-2006.) and State Health Center (2007-2010.) (both institutes working with the same heart team) has been analyzed. The 688 transesophageal echocardiographies (TEE) performed with the suspicion of IE detected 371 vegetations and/or complications of IE. In 82 of the 317 negative cases a second examination was performed revealing 12 IE; thus the negative predictive value of the first TEE proved to be 96,2%, together with the repeated examination 100%. 198 of the positive cases underwent cardiac surgery: native valve IE (NVIE) 133 (67,2%), prosthetic valve IE (PVIE) 46 (23,2%), pacemaker IE (PMIE) 19 (9,6%). Indications of surgery were (1) severe haemodynamic disorder due to IE, (2) IE caused by fungi or uncontrolled bacterial infection, and (3) embolism or high risk for it. Comparing the echocardiographic, surgical and pathological findings the sensitivity of TEE proved to be identical to the literary findings: NVIE 100%; PVIE és PMIE 96%; paravalvular leak, kissing lesion 100%; valve perforation 94%; anular abscess, fistula, pseudoaneurysm 93%, chord rupture 80%. 88,4% (175) of the surgical cases were structural complications. In this group a delay of surgery (from 2004 using surgical indications and timing criteria very similar to the new 2009 ESC IE guideline) brought much higher mortality compared to urgent operation (22,7 vs 13,6%). Under the analyzed period substantially identical incidence (22 vs 21/year) and gender distribution (male 64,3 vs 61,9%, female 35,7 vs 38,1%) were experienced. Besides the increasing rate of PVIE and PMIE (13 vs 19% és 5,1 vs 6,4%) there was a trend of decrease in NVIE (81,2 vs 74,6%). Involvement of the mitral valve in the surgical group became more frequent (39,2 vs 53,1%). 32 (50,8%) of the 63 IE from the 2007-2010 period were nosocomial infections, with a high (38%) mortality. The observed tendencies can be explained by the decreasing incidence of rheumatic carditis, increasing occurence of degenerative valvular disease, more frequent invasive interventions and the use of wide range of implants. TEE has a very important role in the diagnostics of IE: it can quickly and efficiently sort out complicated cases with absolute indication for urgent surgery.

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