Incidence, Predictors, and Mortality of Infective Endocarditis in Adults With Congenital Heart Disease Without Prosthetic Valves
Section snippets
Methods
This study used the Quebec CHD Database—a population-based database of patients with CHD in the Canadian province of Quebec during the period 1983 to 2010.1 Quebec provides universal health-care coverage to its residents and systematically records their contacts with the health-care system in the provincial administrative databases—the Régie de l'assurance maladie du Québec database of medical services claims and the Maintenance et exploitation des données pour l'étude de la clientèle
Results
In an ACHD population of 29,866 patients, comprising 378,901 patient-years of follow-up, we identified 285 (0.95%) cases of IE between 1988 and 2010. The distribution of CHD lesions is described in Table 1, and the lesion-specific incidences of IE are illustrated in Figure 2.
In the case-control study (Table 2), we identified several predictors for the development of IE (Figure 3). Foremost among these predictors are recent medical interventions (odds ratio 12.52, 95% CI 5.23 to 29.97), cardiac
Discussion
In this large population-based analysis, we examined the incident rate of IE in patients with ACHD without previous valve replacement surgery and identified predictors of acquiring IE. In these 29,866 patients with ACHD, we observed an IE incidence rate of 1 case per 1000 person-years, with the highest lesion-specific risk found in those with left-sided CHD (1.61 per 1000 person-years). Several CHD lesion subsets, male sex, diabetes mellitus, and recent medical interventions were associated
Acknowledgment
Dr. Darren Mylotte was supported by the Beth Raby Adult Congenital Heart Disease Fellowship of the Jewish General Hospital. Dr. Ariane Marelli is supported by the Canadian Institutes of Health Research (PHE-141794), the Heart and Stroke Foundation of Canada (00237), and the Fonds de Recherche du Québec - Santé (25307).
Disclosures
The authors have no relevant relationships with industry to disclosure.
References (21)
- et al.
ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J Am Coll Cardiol
(2006) - et al.
Changing mortality in congenital heart disease
J Am Coll Cardiol
(2010) - et al.
Valvular operations in patients with congenital heart disease: increasing rates from 1988 to 2005
Ann Thorac Surg
(2010) - et al.
Congenital heart disease in the general population: changing prevalence and age distribution
Circulation
(2007) - et al.
Specialized adult congenital heart disease care: the impact of policy on mortality
Circulation
(2014) - et al.
Turning 18 with congenital heart disease: prediction of infective endocarditis based on a large population
Eur Heart J
(2011) - et al.
Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors
Circulation
(2013) Endocarditis in congenital heart disease: who is at highest risk?
Circulation
(2013)- et al.
ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation
(2008) - et al.
Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer
Eur Heart J
(2009)
Cited by (27)
Infective endocarditis in adults with congenital heart disease: Contemporary management and related outcomes in Central and South-Eastern European region
2023, International Journal of CardiologyInfective endocarditis after transcatheter pulmonary valve implantation in patients with congenital heart disease: Distinctive features
2023, Archives of Cardiovascular DiseasesInfective endocarditis in adult patients with congenital heart disease
2023, International Journal of CardiologyCitation Excerpt :Patients with CHD are at increased risk for developing IE. It is estimated that CHD patients have an IE risk in excess of 100 times that of the general population [6]. This higher risk is probably related to the high prevalence of residual shunts, cyanosis, prosthetic valves, pacemaker leads, and other implanted materials.
Cardiac diseases and procedures at risk of infective endocarditis
2021, Archives des Maladies du Coeur et des Vaisseaux - PratiqueEducational Case: Tetralogy of Fallot and a Review of the Most Common Forms of Congenital Heart Disease
2020, Academic PathologyCitation Excerpt :The most common type is valvar PS, characterized by thickened leaflets, fused or absent commissures, and often a dome-shaped pulmonary valve. Other more rare types of PS are subvalvar, caused by fibromuscular narrowing below the valve; supravalvar, a narrowing just above the valve; and peripheral PS, discrete areas of narrowed pulmonary arteries, including in branch take-offs.17 Clinical presentation is dependent on the severity of the stenosis and on the likely presence of accompanying cardiac conditions.
Infective endocarditis in a cohort of adult CHD patients
2023, Cardiology in the Young
See page 2282 for disclosure information.