Early post-hospital complications of left-sided infective endocarditis: data from a prospective cohort

Background Infective endocarditis (IE) is a severe disease with high mortality. While in-hospital management is well defined, follow-up after discharge remains less established. Significant complications can occur following hospitalization for IE and a standardized follow-up may allow early identification and management. Purpose This study aimed to describe the prevalence and characteristics of complications of left-sided IE within 6±3 months after discharge and evaluate the impact of early screening on patient management. Methods From September, 2020, to April, 2024, all surviving patients after an hospitalization for left-sided IE in a tertiary center of cardiology were prospectively included. At discharge, a systematic follow-up, including a medical consultation, blood tests, an echocardiography and supplementary investigations with cardiac and/or cerebral computed tomography scan when indicated, has been scheduled at 1 and 6±3 months. Results During the study period, 311 patients were treated for left-sided IE with an in-hospital mortality rate of 22%, the 242 survivors were included (Table 1). The mean age was 65±15 years, 45% had prosthetic valve IE, and 57% underwent surgery. The recommended follow-up was completed by 210 (87%) patients (median time, 6[3–8] months). A total of 77 (32%) patients experienced complications (Table 2), including recurrent IE (n=8), periprosthetic leaks (n=7), paravalvular pseudoaneurysms (n=8), significant regurgitation (n=17), and stroke (n=8). Notably, 43/77 (56%) patients were asymptomatic at diagnosis. Thanks to systematic follow-up, among the 15 patients who required cardiac surgery, 10 patients were operated at an early asymptomatic stage. The global mortality rate during follow-up was 10%. Mortality was significantly higher among patients who missed the scheduled examinations (13/32; 41% vs. 12/210; 6% in the rest of the cohort; p<0.0001). Conclusion Standardized follow-up after left-sided IE frequently identifies early post-hospital complications, often in asymptomatic patients. Early detection seems to positively impact management and could improve prognosis.