One-year Impact of Clinical and Echocardiographic Parameters in Cardiac Implantable Electronic Device Infection after Transvenous Extraction.

Abstract

Introduction: Cardiac implantable electronic device infection (CIEDi) represents a serious complication with a poor prognosis. Many studies have underlined the importance of comorbidities on prognosis, but less is known about the impact of echocardiographic parameters. The aim of our study was to evaluate the clinical and echocardiographic characteristics of patients hospitalized for CIEDi submitted to transvenous extraction and their impact on 1-year follow-up.

Materials and methods: This is a retrospective cohort study that evaluated patients hospitalized for CIEDi in 2019 in two high-volume centers (Cotugno Hospital of Napoli and University Hospital of Pisa).

Results: Sixty-eight patients (72 ± 12 years, 24% females) were included. Isolated pocket infection was present in 30 patients (44%), whereas systemic infection in 38 (56%). In 24 patients (35%), it was possible to identify responsible germ, with a higher prevalence of Staphylococcus epidermidis (24%) and Staphylococcus aureus (16%). The mean ejection fraction (EF) was 45 ± 14%, 44% of patients had one vegetation (11.0 ± 8.0 mm), and 19% had multiple. Transthoracic echocardiography (TTE) failed to identify vegetation in 16 patients, whereas transesophageal echocardiography (TEE) was diagnostic. All patients underwent transvenous extraction of infected devices. After the procedure, echocardiographic ghosts were found in six patients (9%). At 1-year follow-up, all-cause mortality was 16%, mortality for cardiovascular cause was 12%, and no reinfection was recorded. Patients with EF ≤40% showed a significantly higher incidence of all-cause mortality (32% vs. 5%, P = 0.003) and mortality for cardiovascular causes (25% vs. 3%, P = 0.005). At adjusted Cox regression model, reduced EF ≤40% (adjusted hazard ratio [AdjHR] = 9.887, confidence interval [CI] =1.782-54.863; P = 0.009) and diabetes (AdjHR = 5.687, CI = 1.243-26.011; P = 0.025) were strong independent predictors of all-cause mortality. Moreover, reduced EF ≤40% (AdjHR = 17.382, CI = 1.379-219.037; P = 0.027), the presence of ghost (AdjHR = 14.584, CI = 1.465-145.197; P = 0.022), and diabetes (AdjHR = 11.334, CI = 1.506-85.315; P = 0.018) were strong independent predictors of mortality for cardiovascular cause.

Conclusions: Echocardiography (TTE and TEE) is a fundamental tool for the diagnosis and follow-up of CIEDi. In our population, diabetes mellitus and echocardiographic-derived parameters as reduced EF ≤40% and the presence of ghosts were strongly associated with 1-year mortality.