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Original research
Valve regurgitation in patients surviving endocarditis and the subsequent risk of heart failure
  1. Lauge Østergaard1,
  2. Anders Dahl2,
  3. Niels Eske Bruun3,
  4. Louise Bruun Oestergaard4,
  5. Trine Kiilerich Lauridsen5,
  6. Christian Torp-Pedersen6,
  7. Rikke Mortensen7,
  8. Morten Smerup8,
  9. Nana Valeur2,
  10. Lars Koeber1,
  11. Christian Hassager1,
  12. Nikolaj Ihlemann1,
  13. Emil Loldrup Fosbøl1
  1. 1 The Heart Center, Rigshospitalet, Copenhagen, Denmark
  2. 2 Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
  3. 3 Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Zealand, Denmark
  4. 4 Department of Cardiology, Gentofte University Hospital, Hellerup, Copenhagen, Denmark
  5. 5 Department of Cardiology, Rigshospitalet Glostrup, Copenhagen, Denmark
  6. 6 Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
  7. 7 Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
  8. 8 Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Lauge Østergaard, The Heart Center, Rigshospitalet, Copenhagen 2100, Denmark; laugeoestergaard{at}


Background Significant valve regurgitation is common in patients surviving native valve infective endocarditis (IE), however the associated risk of heart failure (HF) subsequent to hospital discharge after IE is sparsely described.

Methods We linked data from the East Danish Endocarditis Registry with administrative registries from 2002 to 2016 and included patients treated medically for IE who were discharged alive. Left-sided valve regurgitation was assessed by echocardiography at IE discharge and examined for longitudinal risk of HF. Multivariable adjusted Cox analysis was used to assess the associated risk of HF in patients with regurgitation (moderate or severe) compared with patients without regurgitation.

Results We included 192 patients, 87 patients with regurgitation at discharge (30 with aortic regurgitation and 57 with mitral regurgitation) and 105 patients without. The cumulative risk of HF at 5 years of follow-up was 28.7% in patients with regurgitation at IE discharge and 12.4% in patients without regurgitation; the corresponding multivariable adjusted HR was 3.53 (95% CI 1.72 to 7.25). We identified an increased associated risk of HF for patients with aortic regurgitation (HR=2.91, 95% CI 1.14 to 7.43) and mitral regurgitation (HR=3.95, 95% CI 1.80 to 8.67) compared with patients without regurgitation. During follow-up, 21.9% and 5.7% underwent left-sided valve surgery among patients with and without regurgitation.

Conclusion In patients surviving IE, treated medically, we observed that severe or moderate left-sided native valve regurgitation was associated with a significantly higher risk of HF compared with patients without regurgitation at IE discharge. Close monitoring of these patients is needed to initiate surgery timely.

  • Endocarditis
  • Aortic regurgitation
  • Mitral regurgitation
  • Heart failure
  • Cardiac surgery

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.