# P-140. Incidence of Heart Failure and Valvular Diseases After Infective Endocarditis: A Propensity-Matched Cohort Study

## TL;DR

This study shows that patients who survive infective endocarditis face a much higher risk of heart failure and valve problems compared to the general population for up to five years.

## Contribution

The study provides population-level evidence of long-term cardiac risks after infective endocarditis using a propensity-matched cohort design.

## Key findings

- Patients with infective endocarditis had a 6.92 times higher risk of heart failure over five years compared to controls.
- Mitral and aortic valve diseases showed the highest risk increases in the infective endocarditis group.
- Heart failure and valve issues began to diverge significantly within the first six months after diagnosis.

## Abstract

Infective endocarditis (IE) is a known risk factor for cardiac remodeling, but population-level data on long-term incidence of heart failure (HF) and valvular disease following IE remain limited.Figure 1.Cumulative incidence of heart failure (HF) in patients with infective endocarditis versus matched general population controls over 5 years of follow-up, beginning 2 weeks after the index event. The incidence of CHF was significantly higher in the infective endocarditis group at 6 months, 1 year, 3 years, and 5 years post-index (all P < .001). Trend analyses showed a sustained increase in cumulative risk in both groups (IE trend P = 0.024; general population trend P = 0.030), with early divergence evident by 6 months.Figure 2:Cumulative incidence of valvular diseases in patients with infective endocarditis (IE) versus matched general population controls over 5 years of follow-up, beginning 2 weeks after the index event. Across all valve types, patients with IE had significantly higher cumulative incidence of regurgitation and stenosis compared to controls (all P < .001 unless otherwise indicated). Mitral and aortic valve involvement showed the highest absolute risks, while right-sided and pulmonic valve outcomes were less frequent. Trend analyses indicated statistically significant increases over time for several valve pathologies in the IE group, particularly mitral regurgitation (P = 0.017) and aortic valve lesions (P = 0.010).

Cumulative incidence of heart failure (HF) in patients with infective endocarditis versus matched general population controls over 5 years of follow-up, beginning 2 weeks after the index event. The incidence of CHF was significantly higher in the infective endocarditis group at 6 months, 1 year, 3 years, and 5 years post-index (all P < .001). Trend analyses showed a sustained increase in cumulative risk in both groups (IE trend P = 0.024; general population trend P = 0.030), with early divergence evident by 6 months.

Cumulative incidence of valvular diseases in patients with infective endocarditis (IE) versus matched general population controls over 5 years of follow-up, beginning 2 weeks after the index event. Across all valve types, patients with IE had significantly higher cumulative incidence of regurgitation and stenosis compared to controls (all P < .001 unless otherwise indicated). Mitral and aortic valve involvement showed the highest absolute risks, while right-sided and pulmonic valve outcomes were less frequent. Trend analyses indicated statistically significant increases over time for several valve pathologies in the IE group, particularly mitral regurgitation (P = 0.017) and aortic valve lesions (P = 0.010).

We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Patients aged ≥18 years with a new diagnosis of infective endocarditis and no prior history of heart failure or structural valvular disease were matched via 1:1 propensity score to a general population cohort without IE or heart failure. Matching was performed on demographic and comorbidity variables. The primary outcome was the incidence of HF at 6 months, 1 year, 3 years, and 5 years post-index. Secondary outcomes included mitral, aortic, tricuspid, and pulmonic valve regurgitation and stenosis. All outcomes were measured beginning 14 days after the index diagnosis to exclude preexisting conditions.

Compared to the general population, the IE cohort had significantly higher 5-year cumulative incidence of HF (6.1% vs 1.2%; hazard ratio [HR], 6.92; 95% CI, 6.14–7.80, Figure 1), mitral regurgitation (2.9% vs 0.6%; HR, 6.53; 95% CI, 5.50–7.76), and aortic regurgitation (1.6% vs 0.2%; HR, 6.41; 95% CI, 4.93–8.33), among other valve outcomes (all P < .001, Figure 2). Time trends for all outcomes were significant across follow-up intervals. Cumulative event curves showed early and sustained divergence between cohorts beginning within the first year (Figure).

Infective endocarditis is associated with a markedly increased risk of incident heart failure and progressive valvular pathology, with differences emerging within the first year and persisting through 5 years. These findings support long-term echocardiographic surveillance and early cardiology follow-up in patients recovering from IE.

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