Anna Polewczyk1, Wojciech Jacheć2, Andrzej Tomaszewski3, Wojciech Brzozowski3, Marek Czajkowski4, Grzegorz Opolski5, Marcin Grabowski5, Marianna Janion6, Andrzej Kutarski3. 1. Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland; 2nd Department of Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland. Electronic address: annapolewczyk@wp.pl. 2. 2nd Department of Cardiology, Silesian Medical University, Zabrze, Poland. 3. Department of Cardiology, Medical University, Lublin, Poland. 4. Department of Cardiac Surgery, Medical University, Lublin, Poland. 5. 1st Department of Cardiology, Medical University of Warsaw, Poland. 6. Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland; 2nd Department of Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland.
Abstract
BACKGROUND: Lead-related infective endocarditis (LRIE) is a serious infectious disease with uncertain prognosis. OBJECTIVE: The purpose of this study was to evaluate the factors that influence survival in patients with LRIE undergoing transvenous lead extraction (TLE). METHODS: Clinical data obtained from 500 consecutive patients with LRIE undergoing TLE in the reference center in the years 2006 to 2015 were retrospectively analyzed. We evaluated the effect of demographic, clinical, and procedure-related factors on 30-day and long-term survival (mean 3-year follow-up). RESULTS: Analysis of 30-day survival after TLE revealed 19 deaths (3.8%), with long-term mortality (mean 3-year follow-up) of 29.3% (146 deaths). Multivariate analysis showed unfavorable effects of age (hazard ratio [HR] 1.056, 95% confidence interval [CI] 1.030-1.082); decreased left ventricular ejection fraction (HR 0.687, 95% CI 0.545-0.866); renal failure (HR 3.099, 95% CI 1.865-5.150); and presence of vegetation fragments remaining after TLE (HR 1.384, 95% CI 1.089-1.760). Log-rank test and Kaplan-Meier survival curves demonstrated statistically worse prognosis in patients with large vegetations (>2 cm) and with vegetation remnants. Better prognosis was associated with LRIE coexisting with generator pocket infection. CONCLUSION: Long-term mortality in LRIE patients is still high. Factors that influence negatively on prognosis include large cardiac vegetations and their remnants after TLE. Such vegetations develop most frequently in patients with decreased left ventricular ejection fraction and renal failure. Probably, early detection of LRIE would tend to limit the formation of large vegetations that invade the adjacent cardiac structures.
BACKGROUND: Lead-related infective endocarditis (LRIE) is a serious infectious disease with uncertain prognosis. OBJECTIVE: The purpose of this study was to evaluate the factors that influence survival in patients with LRIE undergoing transvenous lead extraction (TLE). METHODS: Clinical data obtained from 500 consecutive patients with LRIE undergoing TLE in the reference center in the years 2006 to 2015 were retrospectively analyzed. We evaluated the effect of demographic, clinical, and procedure-related factors on 30-day and long-term survival (mean 3-year follow-up). RESULTS: Analysis of 30-day survival after TLE revealed 19 deaths (3.8%), with long-term mortality (mean 3-year follow-up) of 29.3% (146 deaths). Multivariate analysis showed unfavorable effects of age (hazard ratio [HR] 1.056, 95% confidence interval [CI] 1.030-1.082); decreased left ventricular ejection fraction (HR 0.687, 95% CI 0.545-0.866); renal failure (HR 3.099, 95% CI 1.865-5.150); and presence of vegetation fragments remaining after TLE (HR 1.384, 95% CI 1.089-1.760). Log-rank test and Kaplan-Meier survival curves demonstrated statistically worse prognosis in patients with large vegetations (>2 cm) and with vegetation remnants. Better prognosis was associated with LRIE coexisting with generator pocket infection. CONCLUSION: Long-term mortality in LRIE patients is still high. Factors that influence negatively on prognosis include large cardiac vegetations and their remnants after TLE. Such vegetations develop most frequently in patients with decreased left ventricular ejection fraction and renal failure. Probably, early detection of LRIE would tend to limit the formation of large vegetations that invade the adjacent cardiac structures.
Authors: Olivia C Coiado; Rahul S Yerrabelli; Anton P Christensen; Marcin Wozniak; Alex Lucas; William D O'Brien Journal: JASA Express Lett Date: 2021-08-03
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Andrzej Kleinrok; Łukasz Tułecki; Andrzej Kutarski Journal: Cardiovasc Diagn Ther Date: 2021-04
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Łukasz Tułecki; Andrzej Kleinrok; Andrzej Kutarski Journal: Int J Environ Res Public Health Date: 2021-02-14 Impact factor: 3.390
Authors: Ewa Jędrzejczyk-Patej; Michał Mazurek; Oskar Kowalski; Adam Sokal; Agnieszka Liberska; Mariola Szulik; Tomasz Podolecki; Zbigniew Kalarus; Radosław Lenarczyk Journal: Arch Med Sci Date: 2018-08-07 Impact factor: 3.318