DOI QR코드

DOI QR Code

Infective endocarditis involving an apparently structurally normal valve: new epidemiological trend?

  • Song, Jae-Kwan (Asan Medical Center Heart Institute, University of Ulsan College of Medicine)
  • Received : 2015.05.18
  • Accepted : 2015.05.29
  • Published : 2015.07.01

Abstract

Infective endocarditis (IE) has been increasingly diagnosed in patients without previously detected predisposing heart disease, but its clinical features have yet to be fully determined. A recent single-center study including echocardiographic images and surgical findings investigated the incidence of undiagnosed, clinically silent valvular or congenital heart diseases and healthcare-associated infective endocarditis (HAIE). The study confirmed that a large proportion of patients with IE have no previous history of heart disease. Analysis of underlying disease in these patients showed that undetected mitral valve prolapse was the most common disease, followed by an apparently structurally normal valve. The patients who developed IE of apparently structurally normal valves had different clinical characteristics and worse outcomes. IE involving a structurally normal valve was associated with both nosocomial and non-nosocomial HAIE, whereas community-acquired IE was more frequent than HAIE. The pathophysiologic mechanism involving the development of non-HAIE or community-acquired IE due to predominantly staphylococcal infection in an apparently structurally normal valve is not yet clearly understood. Structurally normal valves are not necessarily free of regurgitation or abnormal turbulence and, given the dynamic nature and fluctuating hemodynamic effects of conditions such as poorly controlled hypertension, end-stage renal disease, and sleep apnea, further investigation is necessary to evaluate the potential role of these diseases in the development of IE. An apparently normal-looking valve is associated with IE development in patients without previously recognized predisposing heart disease, warranting repartition of at-risk groups to achieve better clinical outcomes.

Keywords

References

  1. Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 2002;288:75-81. https://doi.org/10.1001/jama.288.1.75
  2. Desimone DC, Tleyjeh IM, Correa de Sa DD, et al. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association’s endocarditis prevention guidelines. Circulation 2012;126:60-64. https://doi.org/10.1161/CIRCULATIONAHA.112.095281
  3. Duval X, Delahaye F, Alla F, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol 2012;59:1968-1976. https://doi.org/10.1016/j.jacc.2012.02.029
  4. Moreillon P, Que YA, Bayer AS. Pathogenesis of streptococcal and staphylococcal endocarditis. Infect Dis Clin North Am 2002;16:297-318. https://doi.org/10.1016/S0891-5520(01)00009-5
  5. Croft LB, Donnino R, Shapiro R, et al. Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis. Am J Cardiol 2004;94:386-389. https://doi.org/10.1016/j.amjcard.2004.04.045
  6. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC): Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009;30:2369-2413. https://doi.org/10.1093/eurheartj/ehp285
  7. Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;52:676-685. https://doi.org/10.1016/j.jacc.2008.05.008
  8. van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Arch Intern Med 1992;152:1863-1868. https://doi.org/10.1001/archinte.1992.00400210087014
  9. Selton-Suty C, Hoen B, Delahaye F, et al. Comparison of infective endocarditis in patients with and without previously recognized heart disease. Am J Cardiol 1996;77:1134-1137. https://doi.org/10.1016/S0002-9149(96)00150-6
  10. Castillo JC, Anguita MP, Torres F, et al. Comparison of features of active infective endocarditis involving native cardiac valves in nonintravenous drug users with and without predisposing cardiac disease. Am J Cardiol 2002;90:1266-1269. https://doi.org/10.1016/S0002-9149(02)02851-5
  11. Sun BJ, Choi SW, Park KH, et al. Infective endocarditis involving apparently structurally normal valves in patients without previously recognized predisposing heart disease. J Am Coll Cardiol 2015;65:307-309. https://doi.org/10.1016/j.jacc.2014.10.046
  12. McKinsey DS, Ratts TE, Bisno AL. Underlying cardiac lesions in adults with infective endocarditis: the changing spectrum. Am J Med 1987;82:681-688. https://doi.org/10.1016/0002-9343(87)90001-5
  13. Fernandez-Guerrero ML, Verdejo C, Azofra J, de Gorgolas M. Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. Clin Infect Dis 1995;20:16-23. https://doi.org/10.1093/clinids/20.1.16
  14. Fernandez-Hidalgo N, Almirante B, Tornos P, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis 2008;47:1287-1297. https://doi.org/10.1086/592576
  15. Benito N, Miro JM, de Lazzari E, et al. Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med 2009;150:586-594. https://doi.org/10.7326/0003-4819-150-9-200905050-00004
  16. Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J 2010;31:1890-1897. https://doi.org/10.1093/eurheartj/ehq110
  17. Que YA, Moreillon P. Infective endocarditis. Nat Rev Cardiol 2011;8:322-336. https://doi.org/10.1038/nrcardio.2011.43
  18. Wilson LE, Thomas DL, Astemborski J, Freedman TL, Vlahov D. Prospective study of infective endocarditis among injection drug users. J Infect Dis 2002;185:1761-1766. https://doi.org/10.1086/340827
  19. Lopez J, Revilla A, Vilacosta I, et al. Age-dependent profile of left-sided infective endocarditis: a 3-center experience. Circulation 2010;121:892-897. https://doi.org/10.1161/CIRCULATIONAHA.109.877365
  20. Choong CY, Abascal VM, Weyman J, et al. Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography. Am Heart J 1989;117:636-642. https://doi.org/10.1016/0002-8703(89)90739-4
  21. Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999;83:897-902. https://doi.org/10.1016/S0002-9149(98)01064-9

Cited by

  1. Endocarditis: the great mimic of rheumatic diseases vol.46, pp.4, 2015, https://doi.org/10.1177/0049475515624031
  2. The microbiological characteristics of Staphylococcus aureus isolated from patients with native valve infective endocarditis vol.10, pp.1, 2019, https://doi.org/10.1080/21505594.2019.1685631
  3. Molecular Mechanisms of Leonurus Cardiaca L. Extract Activity in Prevention of Staphylococcal Endocarditis-Study on in Vitro and ex Vivo Models vol.24, pp.18, 2015, https://doi.org/10.3390/molecules24183318
  4. Relationship of oral conditions to the incidence of infective endocarditis in periodontitis patients with valvular heart disease: a cross-sectional study vol.24, pp.2, 2015, https://doi.org/10.1007/s00784-019-02973-2