TY - JOUR

T1 - Incidence of infective endocarditis among patients with tetralogy of fallot

AU - Havers-Borgersen, Eva

AU - Butt, Jawad H.

AU - Smerup, Morten

AU - Gislason, Gunnar H.

AU - Torp-Pedersen, Christian

AU - Gröning, Mathis

AU - Schmidt, Michael Rahbek

AU - Søndergaard, Lars

AU - Køber, Lars

AU - Fosbøl, Emil L.

N1 - Publisher Copyright: © 2021 The Authors.

PY - 2021

Y1 - 2021

N2 - BACKGROUND: Patients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple invasive procedures, including pulmonary valve replacement (PVR). Data on the long-term risk of IE are sparse. METHODS AND RESULTS: In this observational cohort study, all patients with ToF born from 1977 to 2018 were identified using Danish nationwide registries and followed from date of birth until occurrence of first-time IE, emigration, death, or end of study (December 31, 2018). The comparative risk of IE among patients with ToF versus age-and sex-matched controls from the background population was assessed. Because of rules on anonymity, exact numbers cannot be reported if the number of patients is <4. A total of 1164 patients with ToF were identified and matched with 4656 controls. Among patients with ToF, 851 (73.1%) underwent early surgical intracardiac repair and 276 (23.7%) underwent PVR during follow-up. During a median follow-up of 20.3 years, 41 (3.5%) patients with ToF (comprising 24 [8.7%] with PVR and 17 [1.9%] without PVR) and <4 (<0.8%) controls were admitted with IE. The incidence rates of IE per 10 000 person-years were 22.4 (95% CI, 16.5– 30.4) and 0.1 (95% CI, 0.01– 0.7) among patients and controls, respectively. Moreover, PVR was associated with a further increased incidence of IE among patients with ToF (incidence rates per 10 000 person-years with and without PVR were 46.7 [95% CI, 25.1– 86.6] and 2.8 [95% CI 2.0– 4.0], respectively). CONCLUSIONS: Patients with ToF are associated with a substantially higher incidence of IE than the background population. In particular, PVR was associated with an increased incidence of IE. With an increasing life expectancy of these patients, intensi-fied awareness, preventive measures, and surveillance of this patient group are decisive.

AB - BACKGROUND: Patients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple invasive procedures, including pulmonary valve replacement (PVR). Data on the long-term risk of IE are sparse. METHODS AND RESULTS: In this observational cohort study, all patients with ToF born from 1977 to 2018 were identified using Danish nationwide registries and followed from date of birth until occurrence of first-time IE, emigration, death, or end of study (December 31, 2018). The comparative risk of IE among patients with ToF versus age-and sex-matched controls from the background population was assessed. Because of rules on anonymity, exact numbers cannot be reported if the number of patients is <4. A total of 1164 patients with ToF were identified and matched with 4656 controls. Among patients with ToF, 851 (73.1%) underwent early surgical intracardiac repair and 276 (23.7%) underwent PVR during follow-up. During a median follow-up of 20.3 years, 41 (3.5%) patients with ToF (comprising 24 [8.7%] with PVR and 17 [1.9%] without PVR) and <4 (<0.8%) controls were admitted with IE. The incidence rates of IE per 10 000 person-years were 22.4 (95% CI, 16.5– 30.4) and 0.1 (95% CI, 0.01– 0.7) among patients and controls, respectively. Moreover, PVR was associated with a further increased incidence of IE among patients with ToF (incidence rates per 10 000 person-years with and without PVR were 46.7 [95% CI, 25.1– 86.6] and 2.8 [95% CI 2.0– 4.0], respectively). CONCLUSIONS: Patients with ToF are associated with a substantially higher incidence of IE than the background population. In particular, PVR was associated with an increased incidence of IE. With an increasing life expectancy of these patients, intensi-fied awareness, preventive measures, and surveillance of this patient group are decisive.

KW - Congenital heart disease

KW - Epidemiology

KW - Infective endocarditis

KW - Tetralogy of Fallot

U2 - 10.1161/JAHA.121.022445

DO - 10.1161/JAHA.121.022445

M3 - Journal article

C2 - 34730003

AN - SCOPUS:85120827125

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 22

M1 - e022445

ER -