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Risk of infective endocarditis in mitral valve prolapse with and without precordial systolic murmurs
Abstract:
The risk of infective endocarditis (IE) associated with a systolic murmur in patients with mitral valve prolapse (MVP) was investigated in a case-control study. The case group comprised all patients with MVP (n = 19) from a series of 136 consecutive adult admissions for IE. Three matched control subjects were chosen for each case from a series of 144 MVP patients without IE. Seventeen of the 19 cases (89%) had documented evidence of systolic murmurs existing before the IE episode; systolic murmurs were documented in 25 of the 57 control subjects (47%). The data indicate a significant increase in the risk of IE in MVP patients with a systolic murmur (p less than 0.01). The absolute probability of IE developing in a patient with MVP and a murmur was estimated to be approximately 1 in 1,400 per year; this was 35 times greater than the probability in a patient with MVP without a murmur. The results suggest that by restricting prophylaxis to MVP patients with a systolic murmur, cover would be provided for almost 90% of those with MVP in whom IE would be likely to develop.
Insights
Patients with mitral valve prolapse (MVP) and a systolic murmur face a significantly higher risk of infective endocarditis (IE). This finding supports targeted antibiotic prophylaxis for MVP patients with murmurs.
Area of Science:
- Cardiology
- Infectious Diseases
- Valvular Heart Disease
Background:
- Mitral valve prolapse (MVP) is a common valvular heart condition.
- Infective endocarditis (IE) is a serious infection of the heart valves.
- The association between systolic murmurs in MVP patients and IE risk requires clarification.
Purpose of the Study:
- To investigate the risk of infective endocarditis (IE) in patients with mitral valve prolapse (MVP).
- To determine if the presence of a systolic murmur increases IE risk in MVP patients.
Main Methods:
- A case-control study design was employed.
- Cases included MVP patients admitted for IE (n=19).
- Controls comprised MVP patients without IE (n=57), matched for age and sex.
Main Results:
- A significant association was found between systolic murmurs and IE in MVP patients (p < 0.01).
- 89% of IE cases had pre-existing systolic murmurs, compared to 47% in controls.
- The annual IE probability for MVP patients with murmurs was ~1 in 1,400, 35 times higher than those without murmurs.
Conclusions:
- Systolic murmurs identify MVP patients at substantially elevated risk for infective endocarditis.
- Targeting antibiotic prophylaxis to MVP patients with systolic murmurs could cover nearly 90% of IE cases.
- This approach may optimize IE prevention strategies in MVP populations.