Institute of Medical Sciences, Jan Kochanowski University, Kielce, Poland; Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland.
Second Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
Pol Arch Intern Med. 2024 Aug 8;134(7-8). doi: 10.20452/pamw.16775. Epub 2024 Jun 17.
Diagnosing lead‑related infective endocarditis (LRIE) often poses a substantial challenge. Current diagnostic criteria include definite and possible LRIE.
The aim of this study was to compare the outcomes of patients with definite and possible LRIE undergoing transvenous lead extraction (TLE) procedures.
A retrospective analysis of data from 3782 patients undergoing TLE between 2006 and 2023 was performed. The study included 838 patients with definite and possible LRIE, whose clinical data on short- and long‑term survival were evaluated.
The comparison of clinical data showed more frequent occurrences of vegetations (81.58% vs 37.21%; P <0.001), positive blood cultures (66.12% vs 51.64%; P <0.001), and septic pulmonary embolism (40.14% vs 13.78%; P <0.001) in the patients with definite LRIE. Long‑term mortality of patients with definite and possible LRIE (median [interquartile range] follow-up, 4.61 [1.04-9.4] and 5.06 [2.07-8.75] years, respectively) was 61.14% and 49.29% (P <0.001). Predictors of mortality in patients with definite LRIE included: advanced age, low left ventricular ejection fraction (LVEF), comorbidities, septic pulmonary embolism, positive blood culture, and presence of an abandoned lead. In possible LRIE, only the influence of advanced age, low LVEF, and comorbidities was demonstrated. There was no documented evidence of a direct impact of a delayed diagnosis on the long‑term survival of patients after TLE.
The study showed better survival in patients with possible LRIE than with definite LRIE, which confirms the need to extend the diagnostic criteria. Introducing appropriate treatment at an early stage of infection improves the prognosis.
诊断与铅相关的感染性心内膜炎（LRIE）常常极具挑战性。目前的诊断标准包括明确和可能的 LRIE。
本研究旨在比较经静脉导线拔除术（TLE）治疗的明确和可能的 LRIE 患者的结局。
对 2006 年至 2023 年间接受 TLE 的 3782 例患者的数据进行回顾性分析。该研究纳入 838 例明确和可能的 LRIE 患者，评估其短期和长期生存的临床数据。
临床数据比较显示，明确 LRIE 患者更常发生赘生物（81.58% vs 37.21%；P<0.001）、阳性血培养（66.12% vs 51.64%；P<0.001）和感染性肺栓塞（40.14% vs 13.78%；P<0.001）。明确和可能的 LRIE 患者的长期死亡率（中位[四分位距]随访时间分别为 4.61[1.04-9.4]和 5.06[2.07-8.75]年）分别为 61.14%和 49.29%（P<0.001）。明确 LRIE 患者死亡的预测因素包括：高龄、左心室射血分数（LVEF）降低、合并症、感染性肺栓塞、阳性血培养和存在废弃导线。在可能的 LRIE 中，仅观察到高龄、LVEF 降低和合并症的影响。没有证据表明延迟诊断对 TLE 后患者的长期生存有直接影响。
本研究显示，与明确的 LRIE 相比，可能的 LRIE 患者的生存更好，这证实了需要扩展诊断标准。在感染早期引入适当的治疗可改善预后。
