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Underlying cardiac lesions in adults with infective endocarditis. The changing spectrum
Abstract:
The spectrum of recognized cardiac lesions underlying infective endocarditis has been changing as a result of the decline in incidence of rheumatic heart disease, the recognition of the entity of mitral valve prolapse, and the improvement in cardiac diagnostic techniques. Sixty-three cases of native valve endocarditis diagnosed in Memphis hospitals between 1980 and 1984 were reviewed. All diagnoses of underlying cardiac lesions were confirmed by two-dimensional echocardiography, cardiac catheterization, and/or histopathologic examination of valve tissues. Major categories of underlying lesions were as follows: mitral valve prolapse, 29 percent; no underlying disease, 27 percent; degenerative lesions of the aortic or mitral valve, 21 percent; congenital heart disease, 13 percent; rheumatic heart disease, 6 percent. Thus, mitral valve prolapse and, in the elderly, degenerative lesions have displaced rheumatic and congenital heart diseases as the major conditions underlying endocarditis. Redundancy of the mitral valve leaflets was noted in 17 of 18 patients in whom endocarditis was superimposed upon mitral valve prolapse. The risk of infective endocarditis appears to be substantially increased in the subset of patients with mitral valve prolapse who exhibit valvular redundancy.
Insights
Mitral valve prolapse and degenerative valve disease are now the leading causes of infective endocarditis, replacing rheumatic and congenital heart conditions. Valvular redundancy in mitral valve prolapse significantly increases endocarditis risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Valvular Heart Disease
Background:
- The spectrum of cardiac conditions predisposing to infective endocarditis (IE) is evolving.
- Declining rheumatic heart disease and improved diagnostics have shifted the landscape of underlying cardiac lesions.
Purpose of the Study:
- To identify the primary cardiac lesions associated with native valve endocarditis.
- To assess the changing prevalence of underlying cardiac conditions in infective endocarditis.
Main Methods:
- Review of 63 native valve endocarditis cases diagnosed between 1980-1984 in Memphis.
- Confirmation of underlying cardiac lesions via two-dimensional echocardiography, cardiac catheterization, and/or valve histopathology.
Main Results:
- Mitral valve prolapse (MVP) was the most common underlying lesion (29%), followed by no underlying disease (27%) and degenerative lesions (21%).
- Rheumatic heart disease (6%) and congenital heart disease (13%) were less frequent.
- Valvular redundancy was noted in 17/18 patients with MVP and IE, indicating a significantly increased risk.
Conclusions:
- Mitral valve prolapse and degenerative valve disease have emerged as the predominant underlying conditions for infective endocarditis.
- Valvular redundancy in MVP patients represents a high-risk subgroup for developing infective endocarditis.