Valve-related complications and acute heart failure in infective endocarditis: beyond structural damage
L Brochado, A Silva, D Cunha, O Baltazar, J Mirinha Luz, N Ilchyshyn, M Martinho, B Ferreira, H Pereira, P FazendasAbstract
Background
Acute heart failure (AHF) is a frequent and life-threatening complication of infective endocarditis (IE), traditionally attributed to acute valvular dysfunction. However, the extent to which valve-related complications independently drive the development of AHF, beyond patient-related factors, remains unclear.
Purpose
To assess the association between valvular involvement, valve-related complications, and the occurrence of AHF in patients hospitalized with IE.
Methods
We conducted a retrospective cohort study including patients admitted with IE. Patients were stratified according to the presence of AHF during hospitalization. Patterns of valvular involvement and local valve-related complications were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with AHF.
Results
Among 221 patients with IE, 79 (35.7%) developed AHF. The main characteristics among patients who developed AHF in the context of IE included being male (81% vs. 66.9%; p=0.029), pre-existing valvular heart disease (57% vs. 36.9%; p=0.005), coronary artery disease (20.3% vs. 6.3%; p=0.003), and a history of heart failure (38.0% vs. 14.8%; p<0.001). Aortic valve involvement was more frequent in patients with AHF than in those without (65.4% vs. 49.0%, p=0.024). Progression to significant valvular regurgitation occurred more commonly in the AHF group (75.0% vs. 50.0%, p<0.001). Paravalvular extension and periannular complications were also more frequent in patients with AHF, although these differences did not reach statistical significance. Despite these associations, neither progression to valvular regurgitation nor other valve-related complications were independently associated with the development of AHF after multivariable adjustment. In contrast, patient-related factors—including pre-existing valvular heart disease (OR 2.54, 95% CI 1.28–5.05), coronary artery disease (OR 4.49, 95% CI 1.56–12.96), and constitutional symptoms at presentation (OR 3.23, 95% CI 1.59–6.52)—were independently associated with AHF.
Conclusions
In IE, although valve-related complications were more prevalent among patients who developed AHF, they were not independently associated with its occurrence after adjustment. These findings suggest that AHF in this setting may reflect a multifactorial process involving both valvular involvement and patient-related factors, highlighting the importance of a comprehensive clinical assessment beyond valve pathology alone.