van Melle Joost P, Roos-Hesselink Jolien W, Bansal Manish, Kamp Otto, Meshaal Marwa, Pudich Jiri, Luksic Vlatka Reskovic, Rodriguez-Alvarez Regino, Sadeghpour Anita, Hanzevacki Jadranka Separovic, Sow Rouguiatou, Timóteo Ana Teresa, Morgado Marisa Trabulo, De Bonis Michele, Laroche Cecile, Boersma Eric, Lancellotti Patrizio, Habib Gilbert
Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands.
Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.
Int J Cardiol. 2023 Jan 1;370:178-185. doi: 10.1016/j.ijcard.2022.10.136. Epub 2022 Oct 21.
Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce.
The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality.
CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]).
CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.
先天性心脏病（CHD）易患感染性心内膜炎（IE），但关于CHD患者IE的特征和预后的数据较少。
ESC-EORP-EURO-ENDO研究是一项针对IE患者（n = 3111）的前瞻性国际研究。在这项预先设定的分析中，描述了成年CHD患者（n = 365，11.7%），并在基线特征和死亡率方面与非CHD患者（n = 2746）进行了比较。
CHD患者（73%为男性，年龄44.8±16.6岁）更年轻，合并症更少。在CHD患者中，14%在住院前进行过牙科手术，而非CHD患者中这一比例为7%（p < 0.001），且CHD患者血培养草绿色链球菌阳性的情况更常见（16.4%对8.8%，p < 0.001）。与非CHD患者一样，IE最常累及左侧瓣膜。对于CHD患者，住院死亡率为9.0%，而非CHD患者为18.1%（p < 0.001），并且在整个700天的随访期间，即使在调整年龄、性别和主要合并症后，CHD患者的生存率也更优（对数秩检验p < 0.0001）（风险比（HR）0.68；95%置信区间0.50 - 0.92）。在CHD人群中，多变量Cox回归显示以下因素（HR及[95%置信区间]）对死亡率有影响：瘘管（HR 6.97 [3.36 - 14.47]）、脑栓塞（HR 4.64 [2.08 - 10.35]）、肾功能不全（HR 3.44 [1.48 - 8.02]）、致病菌为金黄色葡萄球菌（HR 2.06 [1.11 - 3.81]）以及有手术指征时未进行手术（HR 5.93 [3.15 - 11.18]）。
患有IE的CHD患者在全因死亡率方面预后更好。IE发生前牙科手术的高发生率值得进一步研究CHD患者目前抗生素预防的使用情况、需求及疗效。
