AIMS: To evaluate the current management and survival of patients with left-sided infective endocarditis (IE) complicated by congestive heart failure (CHF) in the ESC-EORP European Endocarditis (EURO-ENDO) registry. METHODS AND RESULTS: Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n = 698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations >10 mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p ≤ 0.019). Patients with CHF experienced higher 30-day and 1-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (odds ratio[OR] 2.37, 95% confidence interval [CI] [1.73-3.24; p < 0.001) and 1-year mortality (hazard ratio [HR] 1.69, 95% CI 1.39-2.05; p < 0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n = 618 [88.5%] for each group, both p < 0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson comorbidity index, cerebrovascular accident, Staphylococcus aureus IE, streptococcal IE, uncontrolled infection, vegetation size >10 mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR 0.22, 95% CI 0.12-0.38; p < 0.001) and in 1-year mortality (HR 0.29, 95% CI 0.20-0.41; p < 0.001). CONCLUSION: Congestive heart failure is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and 1-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

Aix Marseille University IRD AP HM MEPHI IHU Mediterranean Infection Marseille France

Cardiology Department Bichat Hospital AP HP Paris France

Cardiology Department University Hospital Centre Centre Hospitalier Universitaire Sart Tilman Liège Belgium

Department of Cardiology Amiens University Hospital Amiens France

Department of Cardiology CHR Citadelle Liège Belgium

Department of Cardiology Clinical Centre of Montenegro Podgorica Montenegro

Department of Cardiology Heart Center University of Bonn Bonn Germany

Department of Cardiology Hôpital de la Timone Aix Marseille University Marseille University Hospital Marseille France

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

Department of cardiology Luxembourg Hospital Centre Luxembourg Luxembourg

Department of Cardiology Marmara University Istanbul Pendik Educational and Research Hospital Istanbul Turkey

Department of Cardiology Santa Marta Hospital Lisbon Portugal

Department of Infectious Diseases Hospital Clinic of Barcelona IDIBAPS University of Barcelona Barcelona Spain

Division of Cardiovascular and Perioperative Medicine Cardiothoracovascular Department Azienda Ospedaliero Universitaria Careggi and University of Florence Florence Italy

Echo Lab Department Hospital de Alta Complejidad en red El Cruce Florencio Varela Buenos Aires Argentina

EURObservational Research Programme European Society of Cardiology Heart House Sophia Antipolis France

Instituto Cardiovascular Hospital Clínico San Carlos Instituto de Investigación Sanitaria del Hospital Clínico San Carlos Madrid Spain

Maladies Infectieuses et Tropicales Centre Hospitalier Régional Universitaire Besançon France; UMR CNRS 6249 Chrono Environnement Université Bourgogne Franche Comté Besançon France

Université de Paris and Institut National de la Santé et de la Recherche Scientifique 1148 Paris France

UR UPJV 7517 Jules Verne University of Picardie Amiens France

Eur J Heart Fail. 2022 Jul;24(7):1239-1248. doi: 10.1002/ejhf.2527. PubMed

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