PURPOSE: Early identification of specific patient subgroups at high risk of developing life–threatening infective endocarditis (IE) complications is of paramount importance. Better stratifi cation may allow more intensive treat-ment of these patients and positively infl uences clinical outcomes.METHODS: We carried out a retrospective survey of consecutive left–sided IE adult patients, admitted over a 15–year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left–sided IE episodes were identified. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p < 0.0001). Valve prolapse/perforation during IE episodes was signifi cantly associated with mitral valve IE (OR 2.136, p = 0.026) and vegetation length (OR 1.055, p = 0.009). Septic shock was sig-nifi cantly related to two main risk factors: S. aureus infection (OR 8.459, p = < 0.0001) and smoking (OR 8.403, p = 0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p = 0.001), followed by S. aureus infection (OR 3.59, p = 0.002). Finally, septic shock (OR 6.000, p = 0.001) represented the most important risk factor of in–hospital mortality. CONCLUSIONS: This study provides the most detailed profile of complication predictors related to left–sided IE in Central Europe. Early individual stratification of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).

Charles University School of Medicine and University Hospital Hradec Kralove 1st Department of Internal Medicine Cardioangiology Hradec Kralove Czech Republic

Department of Cardiology 2nd Medical School Charles University University Hospital Motol Prague Czech Republic

Institute for Clinical and Experimental Medicine Department of Cardiology Prague Czech Republic

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