Heart failure (HF) is the most common complication of infective endocarditis. Not only that, it represents one of the major causes of deaths in native valve infective endocarditis. Consequently, CHF is currently the main indication for early surgery in IE. This single-center study aims to assess to determine prevalence, clinical characteristics and to identify prognostic factors in patients with left-sided native valve IE complicated by congestive heart failure.

Therefore, we conducted a retrospective study between December 2013 and September 2019. Patients with possible or definite infective endocarditis according to the European society of cardiology modified Duke Criteria (2015) were included in the study. Baseline clinical, echocardiographic characteristics and previous history of the patients were obtained from the hospital records.

In total, 114 consecutive patients with definite left-sided native valve IE according to the Duke criteria were included in this analysis. Seventy patients (61%) presented a congestive heart failure at admission or during hospitalization. Comparing the patients with CHF to without CHF, new heart murmur, aortic valve vegetations and severe mitral or aortic regurgitation were more associated with congestive heart failure (P=0.04/P=0.005/P=0.034). Congestive heart failure was independently predictive of in-hospital mortality [OR: 4.2 (2.4–7.0)]. In-hospital mortality was 21.4% for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (13.4% vs. 44.4%, respectively; P<0.05).

Left-sided native valve IE complicated by CHF is more frequent in aortic IE and is associated with severe regurgitation. In CHF patients, early surgery is independently associated with reduced mortality and should be widely considered to improve outcome.