Key result
New or worsened findings on end-of-therapy echocardiography were associated with a significantly increased risk of requiring antimicrobial re-treatment or cardiovascular surgery (HR 25.86) within one year.
Why the study?
The AHA guidelines recommend end-of-therapy echocardiography for infective endocarditis management based on expert opinion without strong evidence.
Cohort (n=243)
No
Hazard Ratio: 25.86 (95% CI 7.64–87.56)
p-value: p=<0.001
Background The American Heart Association (AHA) guidelines for infective endocarditis (IE) management recommend end-of-therapy (EOT) echocardiography (ETE) to “establish a new baseline” and based on “expert opinion.” Methods Medical records of IE patients treated between January 2005 and December 2011 were reviewed. Utilization of ETE and cumulative incidence of re-treatment with antimicrobials or cardiovascular surgery (re-Rx/CVS) within 1 year after EOT were evaluated. Results A total of 243 patients completed clinical follow-up at EOT and 170 at 1 year after EOT. One hundred seventy-seven of 243 (72.8%) underwent ETE, the majority (51.4%) transthoracic echocardiography. One hundred thirty-three of 177 (75.1%) were without new/worsened signs or symptoms (new/w-SSx). One hundred forty-one of 177 (79.7%) overall and 117/133 (87.9%) patients without new/w-SSx had no new ETE findings as compared with initial echocardiography. Among 36/177 (20.3%) with new ETE findings, 20/36 (55.6%) had new/w-SSx; ETE findings were more likely in patients with new/w-SSx (39.2% vs 8.3%; P < 0.001) at EOT. Patients were at increased risk of re-Rx/CVS with either new ETE findings (hazard ratio [HR], 25.86; 95% confidence interval [CI], 7.64–87.56; P < .001) or new/w-SSx (HR, 5.35; 95% CI, 2.87–9.95; P < .001). The highest risk of re-Rx/CVS was in patients with both new/w-SSx and new ETE findings (HR, 45.94; 95% CI, 19.07–110.71). Conversely, only 7/187 (3.4%) patients without new/w-SSx who had an ETE required re-Rx/CVS. Conclusions The majority of patients without new/w-SSx at EOT will not have new ETE findings or need re-Rx/CVS within 1 year after EOT. EOT new/w-SSx is associated with new ETE findings and predicts the need for re-Rx/CVS. Further study is needed to determine whether patients without new/w-SSx need ETE.
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Virk et al. (2020) conducted a cohort in Infective endocarditis (n=243). New or worsened findings on end-of-therapy echocardiography vs. No new or worsened findings on end-of-therapy echocardiography was evaluated on Need for re-treatment with antimicrobials or cardiovascular surgery within 1 year (HR 25.86, 95% CI 7.64-87.56, p=<0.001). New or worsened findings on end-of-therapy echocardiography were associated with a significantly increased risk of requiring antimicrobial re-treatment or cardiovascular surgery (HR 25.86) within one year.
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