Incidence, Predictors, and Mortality of Infective Endocarditis in Adults With Congenital Heart Disease Without Prosthetic Valves

https://doi.org/10.1016/j.amjcard.2017.08.051Get rights and content

Congenital heart disease (CHD) increases the risk of infective endocarditis (IE), though the lesion-specific risk and mortality are poorly defined. Using the population-based Quebec CHD database, we sought to describe the predictors of IE and to evaluate if IE was associated with mortality among adult CHD (ACHD) patients without prior valve replacement surgery. We extracted data on ACHD patients with IE and assessed the lesion-specific incidence of IE, risk factors for IE acquisition, and all-cause 1-year mortality. Among 29,866 ACHD patients, 285 (0.95%) developed IE during follow-up period of 378,901 patient-years, from 1988-2010. The highest and lowest lesion-specific incidences of IE were observed with left-sided lesions (1.61/1000 patient-years) and patent ductus arteriosus (0.24/1000 patient-years), respectively. The following predicted the risk of IE acquisition (odds ratio (OR), 95% confidence interval [CI]): cardiac surgery in the previous 6 months (9.07, 3.98–20.67), endocardial cushion defects (6.65, 3.84–11.53), left-sided lesions (5.11, 3.60–7.25), cyanosis at birth (4.82, 3.12–7.46), ventricular septal defect (2.81, 1.87–4.21), diabetes mellitus (1.65, 1.10–2.48), and recent medical interventions (12.52, 5.23–29.97). Twenty-five (8.77%) patients died within 1-year of IE diagnosis, a substantially elevated rate compared to patients without IE (OR 31.07, 95%CI 16.23–59.49). The risk of death following IE diagnosis was similarly elevated among patients with left-sided, cyanotic and other CHD lesions. In conclusion, the risk of IE in ACHD patients is lesion-specific and is greatest in the context of recent medical interventions. IE is associated with increased 1-year mortality, irrespective of broad CHD lesion grouping.

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)

There are more references available in the full text version of this article.

Cited by (27)

  • Infective endocarditis in adult patients with congenital heart disease

    2023, International Journal of Cardiology
    Citation 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 - Pratique
  • Educational Case: Tetralogy of Fallot and a Review of the Most Common Forms of Congenital Heart Disease

    2020, Academic Pathology
    Citation 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.

View all citing articles on Scopus

See page 2282 for disclosure information.

View full text