The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Long-Term Complications of Native Valve Infective Endocarditis in Non-Addicts: A 15-Year Follow-up Study

M-Pilar Tornos, MD; G. Permanyer-Miralda, MD; Montserrat Olona, MD; Miguel Gil, MD; Enrique Galve, MD; Benito Almirante, MD; and J. Soler-Soler, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: M-Pilar Tornos, MD, Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Po Vall D'Hebron s/n, Barcelona 08035, Barcelona, Spain.

Current Author Addresses: Drs. Tornos, Permanyer-Miralda, Galve, and Soler-Soler: Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Po Vall d'Hebron s/n, Barcelona 08035, Spain.

Drs. Olona and Gil: Servei de Medicina Preventiva, Hospital General Universitari Vall d'Hebron, Po Vall d'Hebron s/n, Barcelona 08035, Spain.

Dr. Almirante: Servei de Medicina Interna, Hospital General Universitari Vall d'Hebron, Po Vall d'Hebron s/n, Barcelona 08035, Spain.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;117(7):567-572. doi:10.7326/0003-4819-117-7-567
Text Size: A A A

Objective: To describe the incidence and clinical manifestations of long-term cardiac complications of endocarditis.

Design: Cohort study.

Setting: University-affiliated tertiary medical center.

Patients: One hundred twelve consecutive patients, survivors from a series of 140 non-addicted patients with a first episode of infective endocarditis on native valves hospitalized from 1975 to 1990. Thirty-two patients had had valve replacement during the active phase of the infection, and the remaining 80 patients received medical treatment alone.

Measurements: Relapse, recurrence, need for late cardiac surgery, and cardiac mortality.

Results: Relapses occurred in three patients (2.7%) and recurrences in five patients (4.5%, incidence density at 15 years, 0.0030 per patient-year). Late cardiac surgery was needed by 47% of the patients treated medically during the active phase, and most had surgery in the first 2 years of follow-up (incidence density, 0.25 per patient-year at 2 years). Aortic valve involvement (relative risk, 2.66; 95% CI, 1.15 to 6.17) and end-diastolic diameter greater than 60 mm (relative risk, 1.04; 95% CI, 1.03 to 2.43) were associated with the need for late surgery in univariate analysis. Multiple logistic regression analysis showed aortic valve involvement to be an independent predictor of the need for late surgery (relative risk, 3.04; CI, 1.23 to 7.54). Only 2 of the 32 patients who had surgery during the active infection needed a second operation during follow-up. At the end of follow-up, the number of patients who had surgery after the onset of the infection was 86 (60% of the whole series). Cardiac death occurred in 16 patients; most deaths were sudden or postoperative and occurred in the first 2 years of follow-up (incidence density, 0.047 per patient-year at 2 years). Independent predictors of death were not found. Survival was 90% at 2 years, 88% at 5 years, 81% at 10 years, and 61% at 15 years.

Conclusions: Survival after infective endocarditis is fair (81% probability of survival at 10 years), and the most common types of cardiac death are sudden and postoperative. Aortic valve involvement is an independent predictor of the need for late cardiac surgery. The rate of recurrences is not negligible (incidence density at 15 years, 0.0030 per patient-year).





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.