Pericardial effusion in prosthetic and native valve infective endocarditis

BACKGROUND: Pericardial effusion (PE) is widely believed to signify more advanced infective endocarditis (IE) and a generally worse outcome. PURPOSE: To determine the prevalence and clinical significance of PE in a series of patients with confirmed native and prosthetic valve infections. METHODS: Data were collected from 338 consecutive patients with definite or possible IE who visited a single referral center; these patients were examined for the presence of PE as detected by transthoracic echocardiography. Clinical characteristics, the incidence of complications, and outcomes were compared between patients with IE with and without PE. IE patients with PE were then divided into two subgroups: those with and those without cardiac prostheses. RESULTS: Eighty-eight patients out of the total 338 (26%) were found to have PE. Compared with patients who did not have PE, patients who did were significantly younger (32.9 ± 13.4 vs 29.0 ± 9.2, p = 0.003), had more left-sided vegetation (55.6% vs 77.3%, p < 0.001), more root abscesses (9.2% vs 25.0%, p < 0.001), needed surgery more frequently (68.0% vs 84.1%, p = 0.001), and had a higher mortality rate (22.0% vs 32.9%, p = 0.03). PE was not found to be a predictor of mortality. No significant difference was found between IE patients with PE with (n = 13) and without (n = 75) prostheses with regard to causative organisms, clinical characteristics, or clinical outcomes. CONCLUSION: Regardless of whether the IE was in native or prosthetic valves, compared with patients without PE, patients with PE had more severe infections and a worse prognosis, but PE was not an independent predictor of mortality.