Predictors of mortality in paravalvular abscess

Tasneem Zehra Naqvi, Jason Boyatt, Robert J. Siegel

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Paravalvular abscess formation is an ominous complication of infective endocarditis; however, prognostic variables in paravalvular abscess are poorly defined. Methods: We examined our experience in patients with paravalvular abscess between 1987 and 2004. Clinical, echocardiographic, microbiologic, and surgical data were examined. Results: There were 45 patients (17 females), age 57 ± 17 years. Twenty-four patients had prosthetic valve endocarditis. Methicillin-sensitive Staphylococcus aureus and coagulase-negative S. aureus were the most common organisms accounting for 25 (56%) cases. Thirty-eight patients (84%) underwent surgery during initial admission. Surgical mortality was 7%, in-hospital mortality was 31%, and 1-year mortality was 38%. Between patients who died and patients who survived, there were no differences in age (61 ± 20 years vs 55 ± 15 years, P = .3), type of microorganism, presence of prosthetic heart valves (47% vs 57%), presence of moderate to severe or severe regurgitation of involved valve (47% vs 57%, P = .37), presence of associated valvular vegetation (93% vs 93%), area of abscess (5.6 ± 2.9 cm2 vs 4.4 ± 3.2 cm2, P = .39), left ventricular systolic function (56% ± 13% vs 56% ± 10%, P = .9), white cell count (13 ± 4 vs 13 ± 7, P = .9), or polymorphonuclear leukocytosis (86% ± 6% vs 81% ± 9%, P = .1). Patients who died were sicker on admission compared with those who survived (33% had stroke or altered mental status vs 7%, P = .03) and had worse renal function compared with those who survived (creatinine 4 ± 4 mg/dL vs 1.6 ± 1.9 mg/dL, P = .009). Conclusion: Neurologic impairment and renal impairment are significant determinants of 1-year survival in patients who present with paravalvular abscess.

Original languageEnglish (US)
Pages (from-to)1404-1408
Number of pages5
JournalJournal of the American Society of Echocardiography
Volume18
Issue number12
DOIs
StatePublished - Dec 2005
Externally publishedYes

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Abscess
Mortality
Endocarditis
Staphylococcus aureus
Kidney
Methicillin
Coagulase
Heart Valves
Leukocytosis
Hospital Mortality
Left Ventricular Function
Nervous System
Creatinine
Cell Count
Stroke
Survival

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of mortality in paravalvular abscess. / Naqvi, Tasneem Zehra; Boyatt, Jason; Siegel, Robert J.

In: Journal of the American Society of Echocardiography, Vol. 18, No. 12, 12.2005, p. 1404-1408.

Research output: Contribution to journalArticle

Naqvi, Tasneem Zehra ; Boyatt, Jason ; Siegel, Robert J. / Predictors of mortality in paravalvular abscess. In: Journal of the American Society of Echocardiography. 2005 ; Vol. 18, No. 12. pp. 1404-1408.
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abstract = "Background: Paravalvular abscess formation is an ominous complication of infective endocarditis; however, prognostic variables in paravalvular abscess are poorly defined. Methods: We examined our experience in patients with paravalvular abscess between 1987 and 2004. Clinical, echocardiographic, microbiologic, and surgical data were examined. Results: There were 45 patients (17 females), age 57 ± 17 years. Twenty-four patients had prosthetic valve endocarditis. Methicillin-sensitive Staphylococcus aureus and coagulase-negative S. aureus were the most common organisms accounting for 25 (56{\%}) cases. Thirty-eight patients (84{\%}) underwent surgery during initial admission. Surgical mortality was 7{\%}, in-hospital mortality was 31{\%}, and 1-year mortality was 38{\%}. Between patients who died and patients who survived, there were no differences in age (61 ± 20 years vs 55 ± 15 years, P = .3), type of microorganism, presence of prosthetic heart valves (47{\%} vs 57{\%}), presence of moderate to severe or severe regurgitation of involved valve (47{\%} vs 57{\%}, P = .37), presence of associated valvular vegetation (93{\%} vs 93{\%}), area of abscess (5.6 ± 2.9 cm2 vs 4.4 ± 3.2 cm2, P = .39), left ventricular systolic function (56{\%} ± 13{\%} vs 56{\%} ± 10{\%}, P = .9), white cell count (13 ± 4 vs 13 ± 7, P = .9), or polymorphonuclear leukocytosis (86{\%} ± 6{\%} vs 81{\%} ± 9{\%}, P = .1). Patients who died were sicker on admission compared with those who survived (33{\%} had stroke or altered mental status vs 7{\%}, P = .03) and had worse renal function compared with those who survived (creatinine 4 ± 4 mg/dL vs 1.6 ± 1.9 mg/dL, P = .009). Conclusion: Neurologic impairment and renal impairment are significant determinants of 1-year survival in patients who present with paravalvular abscess.",
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