CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 83 Methods This study included 90 consecutive patients with a diagnosis of IE, admitted to the Cardiology Department in a tertiary-care university hospital in Egypt in the period from January 2018 to June 2020. Inclusion criteria were patients with definite or possible IE, agedmore than 18 years, who had signed an informed consent based on the ESC 2015 diagnostic criteria.17 Exclusion criteria were any patients already included in an interventional clinical study that would interfere with the patient’s usual care. All included individuals signed a written informed consent to participate in the study. The study has an ethical approval certificate from the ethics committee of the Faculty of Medicine, Alexandria University, Egypt (No. 167/2018). The following information was recorded for each enrolled patient: • Clinical data: age, gender, weight, height, cardiac and noncardiac history, co-morbidities, date and timing of first signs and symptoms, underlying cardiac condition(s), at-risk situation or procedure, vascular and immunological criteria of IE, clinical examination, including cardiac murmur(s), heart failure signs, cardiac and neurological complication(s) and sepsis. • Laboratory data: erythrocyte sedimentation rate, C-reactive protein (CRP), creatinine level, haemoglobin level, white blood cell count, platelet count, blood cultures and serologies performed. • Echocardiographic data: vegetation(s) size(s), abscess, pseudo-aneurysm, valvular and perivalvular lesions, valve regurgitation or stenosis, as well as complete standard echocardiographic studies. • Results of any other imaging techniques performed at admission and during hospitalisation. • Treatment before admission and during hospitalisation, including antibiotic therapy and all other treatments that may have been given. • In-hospital embolic event(s), intracardiac abscess, septicaemia and other complications as well as the need for surgery and overall mortality rate. • Long-term, one-year follow-up data included mortality and related causes, recurrence and relapse, hospitalisations and related causes as well as surgical valvular interventions if any. All descriptive as well as analytical statistics were done using IBM SPSS software version 25. Results The study included 90 patients with a mean age of 36.72 ± 11.89 years, 69 of whom were males (76.67%). The mean body mass index was 24.65 ± 4.84 kg/m2. Forty-four patients had a history of valvular heart disease (48.89%), 17 a history of congenital heart disease (18.89%) and 10 a history of previous diagnosis of IE (11.11%). Thirty-four patients had a history of valvular intervention, either repair or replacement (37.78%), and five patients had an implanted pacemaker (5.55%). The most prevalent risk factor for IE was smoking (48.89%), followed by intravenous (IV) drug use, found in 24 patients (26.67%). Themean duration fromthe first symptomto admission was 13.28 ± 9.29 days (range 1–41 days). Eighty-seven patients presented with fever (69.67%), 50 with dyspnoea (55.56%), 27 had an audible murmur (30%) and 25 patients complained of cough (27.78%). Twenty-four patients presented with pulmonary embolism (26.67%) and four with cerebrovascular stroke (4.44%) (Tables 1, 2; Figs 1, 2). Fifty-six patients had a positive rheumatoid factor (62.22%). The mean CRP level was 114.66 ± 65.99 mg/l, the mean haemoglobin level was 9.99 ± 2.09 g/dl and the mean white cell count was 12.81 ± 4.9 giga/l. Table 1. Baseline demographic and clinical data Parameters Mean ± SD, n (%) or median (range) Baseline data Age (years) 36.72 ± 11.89 35 (19–69) < 30 28 (31.11) 30–39 32 (35.56) 40–49 14 (15.56) 50–59 11 (12.22) > 59 5 (5.56) Male gender 69 (76.67) Cardiac history Heart failure 6 (6.67) Valvular heart disease 44 (48.89) Prosthetic 26 (28.89) Repair 1 (1.11) Ischaemic heart disease 4 (4.44) Congenital heart disease 17 (18.89) Bicuspid aortic valve 13 (14.44) Atrial septal defect 2 (2.22) Ventricular septal defect 2 (2.22) Previous IE 10 (11.11) Cardiac device 5 (5.56) Atrial fibrillation 8 (8.89) Previous cardiac surgery or intervention Valvular 34 (37.78) Coronary 1 (1.11) Devices 5 (5.56) Non-cardiac invasive interventions in the last 6 months Dental 6 (6.67) Gastrointestinal endoscopy 3 (3.33) Neurological 1 (1.11) Urological 2 (2.22) Clinical examination on admission Weight (kg) 71.12 ± 12.83 Height (m) 1.7 ± 0.06 BMI (kg/m2) 24.65 ± 4.84 Systolic BP (mmHg) 109.78 ± 17.42 Diastolic BP (mmHg) 64.67 ± 11.85 Heart rate (bpm) 100.12 ± 14.12 NYHA class I 19 (21.11) NYHA class II 39 (43.33) NYHA class III 26 (28.89) NYHA class IV 6 (6.67) Temperature (°C) 38.8 ± 0.54 Respiratory rate (cpm) 16.04 ± 3.43 Glasgow coma scale 14.91 ± 0.44 Complications on admission Abscess 16 (17.78) Embolic events 30 (33.33) Cerebrovascular 4 (4.44) Pulmonary 24 (26.67) Peripheral 2 (2.22) BMI: body mass index, NYHA: New York Heart Association, bpm: beats per minute, cpm: cycles per minute.
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