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Overview and Comparison of Infectious Endocarditis and Non-infectious Endocarditis: A Review of 814 Autoptic Cases
Rossana Bussani1, Fabio DE-Giorgio2, Giuliano Pesel1
1Institute of Pathological Anatomy, Riuniti Hospital and University of Trieste, Trieste, Italy.
Insights
Autopsy data revealed distinct patterns for infective endocarditis (IE) and non-infective endocarditis (NIE), with IE often missed clinically and NIE linked to malignancies. Autopsy findings offer unique insights compared to clinical databases.
Area of Science:
- Cardiovascular Pathology
- Autopsy Studies
- Clinical Diagnosis
Background:
- Endocarditis, encompassing infective (IE) and non-infective (NIE) forms, presents diagnostic challenges.
- Autopsy data provides a unique perspective on endocarditis prevalence and characteristics.
- Previous studies often rely on clinical or surgical databases.
Purpose of the Study:
- To analyze and compare autopsy findings of infective and non-infective endocarditis.
- To identify differences in patient demographics, comorbidities, and pathological features between IE and NIE.
- To highlight discrepancies between autopsy-based and clinical/surgical database findings.
Main Methods:
- Retrospective analysis of 50,403 clinical autopsies performed between 1983 and 2006.
- Inclusion of 814 endocarditis cases: 409 IE and 405 NIE.
- Data collection included demographics, clinical history, comorbidities, valve status, pathological features, complications, and microbiology.
Main Results:
- IE diagnosis was frequently missed in clinical settings.
- IE cases were more prevalent in patients with prior valve issues or surgery.
- Malignancies were common comorbidities in NIE cases.
Conclusions:
- Autopsy findings for IE and NIE differ from those typically reported in surgical and clinical databases.
- The reliance on autopsy data offers a distinct epidemiological view of endocarditis.
- Clinical underdiagnosis of IE is a significant concern highlighted by autopsy data.
Aim:
We examined evidence on infective and non-infective endocarditis obtained from a database of 50,403 clinical autopsies performed at an Italian general hospital between January 1983 and December 2006.
Materials And Methods:
Out of 814 endocarditis cases, 409 were of infective endocarditis (IE) and 405 non-infective (NIE). The median age at the time of death was 78 years for those with IE and 83 for those with NIE. Data were collected on gender, clinical history, comorbidities, kind of affected valve (non-prosthetic/mechanical/biological), pathological features of endocarditis, endocarditis complications and microbiological agents.
Results:
The diagnosis of IE was frequently missed and these conditions were often complicated by cardiovascular events. IE was more common among patients with prior valve infection or cardiovascular surgery, while malignancies were frequent comorbidities of NIE.
Conclusion:
In general, we found several data that differ from those generally present in the scientific literature, and this could be explained by the fact that data on IE and NIE are generally obtained from surgical and clinical databases, while we analysed only autoptic cases.
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