Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry
Authors: Sambola Antonia , Lozano-Torres Jordi , Boersma Eric , Olmos Carmen , Ternacle Julien , Calvo Francisco , Tribouilloy Christophe , Reskovic-Luksic Vlatka , Separovic-Hanzevacki Jadranka , Park Seung-Woo , Bekkers Sebastiaan , Chan Kwan-Leung , Almaghraby Abdallah , Iung Bernard , Lancellotti Patrizio , Habib Gilbert ,   the ESC EORP EURO-ENDO Registry Investigator Group, Ferrari R , Alonso A , Bax J , Blomström-Lundqvist C , Gielen S , Maggioni A P , Lancellotti P , Maniadakis N , Pinto F , Ruschitzka F , Tavazzi L , Vardas P , Weidinger F , Zeymer U , Vahanian A , Budaj A , Dagres N , Danchin N , Delgado V , Emberson J , Friberg O , Gale C P , Heyndrickx G , Iung B , James S , Kappetein A P , Maggioni A P , Maniadakis N , Nagy K V , Parati G , Petronio A-S , Pietila M , Prescott E , Ruschitzka F , Van de Werf F , Weidinger F , Zeymer U , Habib Gilbert , Lancellotti Patrizio , Cosyns Bernard , Donal Erwan , Erba Paola , Habib Gilbert , Iung Bernard , Maggioni Aldo P , Popescu Bogdan A , Prendergast Bernard , Tornos Pilar , Tatar-Chentir Nora Nabila Ali , Al-Mallah Mouaz , Aneq Meriam Astrom , Athanassopoulos George , Badano Luigi Paolo , Benyoussef Soraya , Aranda Erick Calderon , Cardim Nuno Miguel , Chan Kwan-Leung , Cosyns Bernard , Cruz Ines , Edvardsen Thor , Goliasch Georg , Habib Gilbert , Hagendorff Andreas , Hristova Krasimira , Iung Bernard , Kamp Otto , Kang Duk-Hyun , Kong William , Matskeplishvili Simon , Meshaal Marwa , Mirocevic Maja , Neskovic Aleksandar N , Pazdernik Michal , Plonska-Gosciniak Edyta , Popescu Bogdan A , Prendergast Bernard , Raissouni Maha , Ronderos Ricardo , Sade Leyla Elif , Sadeghpour Anita , Sambola Antonia , Sengupta Shantanu , Separovic-Hanzevacki Jadranka , Takeuchi Masaaki , Tucay Edwin , Rodrigues Ana Clara Tude , Varga Albert , Vaskelyte Jolanta , Yamagata Kentaro , Yiangou Kyriakos , Zaky Hosam , Ronderos R , Avegliano G , Fernandez Oses P , Filipini E , Granada I , Iribarren A , Mahia M , Nacinovich F , Ressi S , Obregon R , Bangher M , Dho J , Cartasegna L , Plastino M L , Novas V , Shigel C , Reyes G , De Santos M , Gastaldello N , Granillo Fernandez M , Potito M , Streitenberger G , Velazco P , Casabé J H , Cortes C , Guevara E , Salmo F , Seijo M , Weidinger F , Heger M , Brooks R , Stöllberger C , Ho C-Y , Perschy L , Puskas L , Goliasch G , Binder C , Rosenhek R , Schneider M , Winter M-P , Hoffer E , Melissopoulou M , Lecoq E , Legrand D , Jacquet S , Massoz M , Lancellotti P , Pierard L , Dulgheru R , Marchetta S , D’Emal C , Oury C , Cosyns B , Droogmans S , Kerkhove D , Motoc A , Plein D , Roosens B , Soens L , Weytjens C , Lemoine I , Rodrigus I , Paelinck B , Amsel B , Unger P , Konopnicki D , Beauloye C , Pasquet A , Pierard S , Vancraeynest D , Vanoverschelde J L , Sinnaeve F , Andrade J L , Tude Rodrigues A C , Staszko K , Dos Santos Monteiro R , Miglioranza M H , Shuha D L , Alcantara M , Cravo V , Fazzio L , Felix A , Iso M , Musa C , Siciliano A P , Villaca Filho F , Braga J , Rodrigues A , Silva R , Vilela F , Rodrigues D , Silva L , Morhy S , Fischer C , Silva R , Vieira M , Afonso T , Abreu J , Falcao S N , Moises V , Gouvea A , João G , Mancuso F , Silva C , Souza A C , Abboud C S , Bellio de Mattos Barretto R , Ramos A , Arnoni R , Assef J E , Della Togna D J , Le Bihan D , Miglioli L , Romero Oliveira A P , Tadeu Magro Kroll R , Cortez D , Gelape C L , Pereira Nunes M d.C , De Abreu Ferrari T C , Chan K-L , Hay K , Le V , Page M , Poulin F , Sauve C , Serri K , Mercure C , Beaudoin J , Pibarot P , Sebag I , Rudski L , Ricafort G , Barsic B , Krajinovic V , Vargovic M , Separovic-Hanzevacki J , Lovric D , Reskovic-Luksic V , Vincelj J , Jaksic Jurinjak S , Yiannikourides V , Ioannides M , Kyriakou C , Pofaides C , Masoura V , Yiangou K , Pudich J , Linhart A , Siranec M , Marek J , Blechova K , Kamenik M , Pazdernik M , Pelouch R , Coufal Z , Mikulica M , Griva M , Jancova E , Mikulcova M , Taborsky M , Precek J , Jecmenova M , Latal J , Widimsky J , Butta T , Machacek S , Vancata R , Spinar J , Holicka M , Pow Chon Long F , Anzules N , Bajana Carpio A , Largacha G , Penaherrera E , Moreira D , Mahfouz E , Elsafty E , Soliman A , Zayed Y , Aboulenein J , Abdel-Hay M , Almaghraby A , Abdelnaby M , Ahmed M , Hammad B , Saleh Y , Zahran H , Elgebaly O , Saad A , Ali M , Zeid A , El Sharkawy R , Meshaal M , Al Kholy A , Doss R , Osama D , Rizk H , Elmogy A , Mishriky M , Assayag P , El Hatimi S , Botelho-Nevers E , Campisi S , Fuzellier J-F , Gagneux-Brunon A , Pierrard R , Tulane C , Detoc M , Mehalla T , Boutoille D , Habash O Al , Asseray-Madani N , Biron C , Brochard J , Caillon J , Cueff C , Le Tourneau T , Lecompte A S , Lecomte R , Lefebvre M , Magali Michel M M , Pattier S , Delarue S , Le Bras M , Orain J , Faucher J-F , Aboyans V , Beeharry A , Durox H , Lacoste M , Magne J , Mohty D , David A , Pradel V , Sierra V , Neykova A , Bettayeb B , Elkentaoui S , Tzvetkov B , Landry G , Strady C , Ainine K , Baumard S , Brasselet C , Tassigny C , Valente-Pires V , Lefranc M , Hoen B , Lefevre B , Curlier E , Callier C , Fourcade N , Jobic Y , Ansard S , Le Berre R , Le Roux P , Le Ven F , Pouliquen M-C , Prat G , Bouchart F , Savoure A , Alarcon C , Chapuzet C , Gueit I , Tribouilloy C , Bohbot Y , Peugnet F , Gun M , Iung B , Duval X , Lescure X , Ilic-Habensus E , Sadoul N , Selton-Suty C , Chevalier E , Goehringer F , Huttin O , Garcia R , Le Marcis V , Tattevin P , Donal E , Flecher E , Revest M , Habib G , Hubert S , Casalta J-P , Gouriet F , Arregle F , Cammilleri S , Tessonnier L , Riberi A , Chirouze C , Bouiller K , Brunel A-S , Fournier D , Hustache-Mathieu L , Klopfenstein T , Moreau J , Lim P , Oliver L , Ternacle J , Moussafeur A , Chavanet P , Piroth L , Buisson M , Mahy S , Martins C , Salmon-Rousseau A , Gohier S , Piper C , Börgermann J , Guckel D , Horstkotte D , Brockmeier B , Winkelmann E , Hagendorff A , Grey D , Nickenig G , Schueler R , Öztürk C , Stöhr E , Hamm C , Walther T , Brandt R , Frühauf A-C , Hartung C T , Hellner C , Wild C , Becker M , Hamada S , Kaestner W , Stangl K , Knebel F , Baldenhofer G , Brecht A , Dreger H , Isner C , Pfafflin F , Stegemann M , Zahn R , Fraiture B , Kilkowski C , Karcher A-K , Klinger S , Tolksdorf H , Tousoulis D , Aggeli C , Sarri G , Sideris S , Venieri E , Athanassopoulos G , Tsiapras D , Armenis I , Koutsiari A , Floros G , Grassos C , Dragasis S , Rallidis L , Varlamos C , Michalis L , Naka K , Bechlioulis A , Kotsia A , Lakkas L , Pappas K , Papadopoulos C , Kiokas S , Lioni A , Misailidou S , Barbetseas J , Bonou M , Kapelios C , Tomprou I , Zerva K , Manolis A , Hamodraka E , Athanasiou D , Haralambidis G , Poulimenos L , Samaras H , Nagy A , Bartykowszki A , Gara E , Sengupta S , Mungulmare K , Kasliwal R , Bansal M , Bhan A , Ranjan S , Kyavar M , Maleki M , Noohi Bezanjani F , Sadeghpour A , Alizadehasl A , Boudagh S , Ghavidel A , Moradnejad P , Pasha H R , Ghadrdoost B , Gilon D , Strahilevitz J , Israel S , Wanounou M , d’Agostino C , Colonna P , De Michele L , Fumarola F , Stante M , Marchionni N , Scheggi V , Alterini B , Del Pace S , Stefano P , Sparano C , Badano L P , Muraru D , Ruozi N , Tenaglia R , Limbruno U , Cresti A , Baratta P , Solari M , Giannattasio C , Moreo A , De Chiara B , Lopez Montero B , Musca F , Orcese C A , Panzeri F , Russo C F , Spano F , Alfieri O , De Bonis M , Agricola E , Busnardo E , Carletti S , Castiglioni B , Chiappetta S , Del Forno B , Ferrara D , Guffanti M , Iaci G , Lapenna E , Nisi T , Oltolini C , Pajoro U , Pasciuta R , Ripa M , Scarpellini P , Tassan Din C , Meneghin R , Schiavi D , Piscione F , Citro R , Benvenga R M , Greco L , Prota C , Radano I , Soriente L , Bellino M , Vece D Di , Santini F , Salsano A , Olivieri G M , Turrini F , Messora R , Tondi S , Olaru A , Agnoletto V , Grassi L , Leonardi C , Sansoni S , Del Ponte S , Actis Dato G M , De Martino A , Ohte N , Kikuchi S , Wakami K , Aonuma K , Seo Y , Ishizu T , Machino-Ohtsuka T , Yamamoto M , Iida N , Nakajima H , Nakagawa Y , Izumi C , Amano M , Miyake M , Takahashi K , Shiojima I , Miyasaka Y , Maeba H , Suwa Y , Taniguchi N , Tsujimoto S , Kitai T , Ota M , Yuda S , Sasaki S , Hagiwara N , Yamazaki K , Ashihara K , Arai K , Saitou C , Saitou S , Suzuki G , Shibata Y , Watanabe N , Nishino S , Ashikaga K , Kuriyama N , Mahara K , Abe K , Fujimaki H , Okubo T , Shitan H , Takanashi S , Terada M , Yamamoto H , Sata M , Yamada H , Kusunose K , Saijo Y , Seno H , Yuichiro O , Sakata Y , Mizuno H , Nakatani S , Onishi T , Sengoku K , Sera F , Park S W , Eun Kyoung K , Ga Yeon L , Hwang J-w , Jin-Oh C , Park S-J , Sang-Chol L , Sung-A C , Jang S Y , Kang D-H , Heo R , Lee S , Song J-M , Jung E , Plisiene J , Dambrauskaite A , Gruodyte G , Jonkaitiene R , Vaskelyte J , Mizariene V , Atkocaityte J , Zvirblyte R , Sow R , Codreanu A , De la Vega E C L , Michaux C , Staub T , Jacobs-Orazi L , Mallia Azzopardi C , Xuereb R G , Piscopo T , Borg D , Casha R , Farrugia J , Fenech M , Pllaha E , Vella C , Yamagata K , Grib L , Raevschi E , Grejdieru A , Balan G , Cardaniuc I , Cardaniuc L , Corcea V , Feodorovici A , Gaina V , Girbu L , Jimbei P , Kravcenco D , Panfile E , Prisacari E , Samohvalov E , Samohvalov S , Sceglova N , Benesco I , Marian V , Sumarga N , Mirocevic M , Bozovic B , Bulatovic N , Lakovic P , Music L , Roos-Hesselink J , Budde R , Gamela T , Wahadat A , Kamp O , Meijers T , Van Melle J P , Deursen V M , Crijns H , Bekkers S , Cheriex E , Gilbers M , Kietselaer B , Knackstedt C , Lorusso R , Schalla S , Streukens S , Chamuleau S , Cramer M-J , Teske A , Van der Spoel T , Wind A , Liesbek O , Lokhorst J , Van Heusden H , Tanis W , Van der Bilt I , Vriend J , De Lange-van Bruggen H , Karijodikoro E , Riezebos R , van Dongen E , Schoep J , Stolk V , Axler O , Baumann F , Lebras S , Edvardsen T , Offstad J T , Beitnes J O , Helle-Valle T , Skulstad H , Skardal R , Qamar N , Furnaz S , Ahmed B , Butt M H , Khanzada M F , Saghir T , Wahid A , Hryniewiecki T , Szymanski P , Marzec K , Misztal-Ogonowska M , Kosmala W , Przewlocka-Kosmala M , Rojek A , Woznicka K , Zachwyc J , Lisowska A , Kaminska M , Kasprzak J , Kowalczyk E , Strzecka D F , Wejner-Mik P , Trabulo M , Freitas P , Ranchordas S , Rodrigues G , Pinto P , Queiros C , Azevedo J , Marques L , Seabra D , Branco L , Abreu J , Cruz M , Galrinho A , Moreira R , Rio P , Timoteo A T , Selas M , Cardim N M , Carmelo V , Duque Neves B , Pereira H , Cruz I , Guerra A , Marques A , Pintassilgo I , Tomescu M C , Trofenciuc N-M , Andor M , Bordejevic A , Branea H S , Caruntu F , Cirin L , Citu I M , Cotoraci C A , Darabantiu D , Farcas R , Marincu I , Mavrea A , Onel M F , Parvanescu T , Pop D , Pop-Moldovan A L , Puticiu M I , Velcean L A , Ionac A , Cozma D , Mornos C , Goanta F , Popescu I , Beyer R , Mada R , Rancea R , Rosianu H , Tomoaia R , Stanescu C , Kobalava Z , Karaulova J , Kotova E , Milto A , Pisaryuk A , Povalyaev N , Sorokina M , Alrahimi J , Elshiekh A , Jamiel A , Ahmed A , Al-Mallah M , Attia N , Putnikovic B , Neskovic A , Dimic A , Ivanovic B , Matic S , Trifunovic D , Petrovic J , Kosevic D , Dabic P , Milojevic P , Petrovic I , Stojanovic I , Srdanovic I , Kovacevic M , Redzek A , Stefanovic M , Susak S , Velicki L , Vulin A , Yeo T C , Kong F W K , Poh K K , Vilacosta I , Abd El- Nasser M , Ferrera C , Olmos C , Calvo Iglesias F , Blanco-Gonzalez E , Bravo Amaro M , Germinas A N , Lopez-Rodriguez E , Lugo Adan J , Pazos-Lopez P , Pereira Loureiro M , Perez M T , Raposeiras-Roubin S , Rasheed Yas S , Suarez-Varela M-M , Vasallo Vidal F , Garcia-Dorado D , Sambola A , Fernandez-Hidalgo N , Gonzalez-Alujas T , Lozano J , Maisterra O , Pizzi N , Rios R , Tornos P , Bayes-Genis A , Pedro Botet L , Vallejo N , Berastegui E , Llibre C , Mateu L , Nunez R , Quesada D , Bosch Portell D , Aboal Vinas J , Albert Bertran X , Brugada Tarradellas R , Loma-Osorio Ricon P , Tiron de Llano C , Arnau M A , Bel A , Blanes M , Osa A , Anguita M , Carrasco F , Castillo J , Zamorano J L , Moya Mur J L , Alvaro M , Fernandez-Golfin C , Monteagudo J M , Navas Elorza E , Farinas Alvarez M C , Aguero Balbin J , Arminanzas C , Arnaiz de las Revillas F , Arnaiz Garcia A , Cobo Belaustegui M , Fernandez Sampedro M , Gutierrez Cuadra M , Gutierrez-Diez J F , Zarauza J , Garcia Cuello L , Gonzalez Rico C , Rodriguez-Alvarez R , Goikoetxea J , Montejo M , Miro J , Almela M , Ambrosioni J , Falces C , Fuster D , Garcia-de-la-Maria C , Hernandez-Meneses M , Llopis J , Marco F , Moreno A , Quintana E , Sandoval E , Tellez A , Tolosana J M , Vidal B , Ruiz-Zamora I , Bardaji Ruiz A , Sanz Girgas E , Garcia-Pardo G , Guillen Marzo M , Rodriguez Oviedo A , Villares Jimenez A , Abid L , Hammami R , Kammoun S , Mourali M S , Mghaieth Zghal F , Ben Hlima M , Boudiche S , Ouali S , Zakhama L , Antit S , Slama I , Gulel O , Sahin M , Sade L E , Karacaglar E , Kucukoglu S , Cetinarslan O , Yasar U S , Canpolat U , Mutlu B , Atas H , Dervishova R , Ileri C , Zaky H , Alhashmi J , Baslib F , Tahir J , Zarger P , Woldman S , Menezes L , Primus C , Uppal R , Bvekerwa I , Chandrasekaran B , Kopanska A , Prendergast B , Cannata S , Chambers J , Hancock J , Klein J , Rajani R , Ursi M P , Dworakowski R , Fife A , Breeze J , Browne-Morgan M , Gunning M , Streather S , Asch F , Zemedkun M , Alyavi B , Uzokov J 
Published: August 2023

Abstract

Background and Aims
Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes.

Methods
The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016–18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality.

Results
There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was &gt;10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13–1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54–2.33, P &lt; .0001), history of heart failure (HR 1.53, 95% CI 1.21–1.93, P = .0004), creatinine &gt;2 mg/dL (HR 1.59, 95% CI 1.25–2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08–1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12–1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08–6.79, P &lt; .0001), alcohol abuse (HR 1.45, 95% CI 1.04–2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29–3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05–1.61, P = .016) (C-statistic = .68).

Conclusions
Prognosis after LSIE is determined by multiple factors, including vegetation size.