Related Experiment Video
Updated: Mar 14, 2026
Visualization of Streptococcus pneumoniae within Cardiac Microlesions and Subsequent Cardiac Remodeling
Published on: April 7, 2015
Clinical significance of hyperhomocysteinemia in infective endocarditis: A case-control study
Domenico Iossa1, Rosa Molaro, Roberto Andini
1aInternal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N. bUnit of Infectious & Transplant Medicine cUnit of Clinical Biochemistry dUnit of Cardiac Surgery A.O.R.N. dei Colli - Ospedale Monaldi, Napoli, Italy.
Insights
Hyper-homocysteinemia (h-Hcy) is common in infective endocarditis (IE) and linked to worse kidney function and higher mortality, but not embolic events. It may indicate cardiac issues rather than infection.
Area of Science:
- Cardiology
- Nephrology
- Hematology
Background:
- Blood coagulation is central to infective endocarditis (IE) pathogenesis.
- Thrombophilia may worsen IE vegetation and embolic risks.
- Hyper-homocysteinemia (h-Hcy) is a potential thrombophilic factor.
Purpose of the Study:
- To determine the prevalence, correlates, and clinical impact of h-Hcy in IE patients.
- To compare h-Hcy levels in IE patients with valvular heart disease (VHD) patients and healthy controls.
Main Methods:
- Plasma homocysteine (Hcy) levels were measured in 246 IE patients, 258 VHD patients, and 106 healthy controls.
- Prevalence of h-Hcy, vegetation size, embolic complications, chronic kidney disease, and 1-year mortality were assessed.
- Logistic regression analysis identified independent predictors of mortality.
Main Results:
- IE patients had Hcy levels similar to VHD patients; h-Hcy prevalence was high in both groups (48.8% IE, 55.8% VHD).
- h-Hcy was not associated with vegetation size or embolic complications in IE.
- IE patients with h-Hcy showed higher rates of chronic kidney disease and 1-year mortality (19.6% vs 9.9%).
Conclusions:
- h-Hcy is common in IE and associated with poorer renal function and increased mortality.
- h-Hcy in IE may serve as a marker for cardiac dysfunction, not necessarily infection.
- h-Hcy does not appear to promote IE vegetation or embolic complications.
Abstract:
Blood coagulation plays a key role in the pathogenesis of infective endocarditis (IE). Conditions associated with thrombophilia could enhance IE vegetation formation and promote embolic complications.In this study, we assessed prevalence, correlates, and clinical consequences of hyper-homocysteinemia (h-Hcy) in IE.Homocysteine (Hcy) plasma levels were studied in 246 IE patients and 258 valvular heart disease (VHD) patients, as well as in 106 healthy controls.IE patients showed Hcy levels comparable to VHD patients (14.9 [3-81] vs 16 [5-50] μmol/L, respectively; P = 0.08). H-Hcy was observed in 48.8% of IE patients and 55.8% of VHD (P = 0.13). Vegetation size and major embolic complications were not related to Hcy levels. IE patients with h-Hcy had a higher prevalence of chronic kidney disease and a higher 1-year mortality (19.6% vs 9.9% in those without h-Hcy; OR 2.21 [1.00-4.89], P = 0.05). However, at logistic regression analysis, h-Hcy was not an independent predictor of 1-year mortality (OR 1.87 [95% CI 0.8-4.2]; P = 0.13).Our data suggest h-Hcy in IE is common, is related to a worse renal function, and may be a marker of cardiac dysfunction rather than infection. H-Hcy does not appear to favor IE vegetation formation or its symptomatic embolic complications.
Related Concept Videos
01:25Endocarditis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:29Endocarditis IV: Nursing Management
01:18Endocarditis III: Medical Management
01:21Myocarditis I: Introduction
01:27Myocarditis II: Clinical Features and Diagnostic Tests