Supplementary Material for: The impact of left ventricular structure and function on mortality in patients with aortic valve infective endocarditis treated with aortic valve replacement

Introduction: Left ventricular (LV) ejection fraction (LVEF) and LV end-diastolic diameter (LVEDd) are well-established predictors of adverse cardiovascular events. However, the possible association with survival in patients with infective endocarditis (IE) treated with aortic valve replacement (AVR) is underexplored. Additionally, it is important to investigate whether sex modifies these associations. Methods: We retrospectively recruited 170 consecutive patients with IE treated with AVR from three cardiac surgery tertiary hospitals in Scandinavia. Echocardiography was performed both pre- and postoperatively. Baseline characteristics, preoperative blood samples, postoperative complications, echocardiographic and angiographic data were compared between surviving and deceased patients at both short- (1-year) and long-term (5-year) follow-up. Results: The mean age in the entire study population was 58.5±15.1 years, and 80.0% were males. The mean LVEF was 54±11% preoperatively, decreasing to 51±11% postoperatively. The mean baseline LVEDd was 5.8±0.9 cm in males and 5.0±0.9 cm in females (p<0.001), decreasing to 5.2±0.9 cm in males and 4.7±0.6 cm in females after surgery (p=0.006). At short-term follow-up, reduced postoperative LVEF (<50%) was more common in non-survivors (46.2% vs. 26.2%, p=0.040), with the strongest association observed in females (71.4% vs. 25.9%, p=0.025). Similarly, during long-term follow-up, deceased female patients had a higher prevalence of reduced preoperative LVEF (<50%) compared to surviving female patients (30.0% versus 4.2%, p=0.033). LVEDd was significantly greater in female non-survivors compared to survivors at both short-term (5.7 ± 1.1 cm vs. 4.9 ± 0.8 cm, p=0.043) and long-term follow-up (5.5 ± 0.9 cm vs. 4.8 ± 0.8 cm, p=0.046), an association not observed in male patients. Conclusion: Our study found that both pre- and postoperative LVEF, as well as preoperative LVEDd, were associated with poorer outcomes in patients with IE undergoing AVR, particularly among female patients. These results highlight the importance of tailored clinical management strategies based on sex-specific risk profiles. Further research is needed to validate these findings and develop interventions to mitigate the observed risks.