Tricuspid vs Bicuspid Aortic Valve Endocarditis: Delayed Symptom-Onset-to-Diagnosis Time in Bicuspid Patients...

Bicuspid aortic valve infective endocarditis (BAV-IE) patients exhibit more perivalvular complications as compared to tricuspid aortic valve (TAV) IE.

We examined symptom-to-diagnosis time in BAV-IE vs TAV-IE and its effect on outcomes.

Consecutive adult patients (≥18 years) with native aortic valve IE were retrospectively reviewed from all Mayo Clinic US sites from 2015 to 2021. Clinical features, microbiology, and outcomes were extracted from electronic health records. IE-related major adverse cardiovascular events (IE-related MACE) were perivalvular infection extension, septic embolism, heart failure, and/or surgery.

There were 52 BAV-IE patients (mean age 47 ± 15 years, 85% [44/52] male) and 244 with TAV-IE (mean age 65 ± 14 years, 72% [177/244] male). Compared to TAV-IE, BAV-IE patients showed higher prevalence of streptococcal infections (54% [28/52] vs28% [69/244]; P = 0.0004), and higher suspected dental procedure source (10 [5/52] vs 2% [5/244]; P = 0.006). BAV-IE patients exhibited delayed symptom-to-diagnosis time (median 34 vs7 days; P < 0.0001). IE-related major adverse cardiovascular event (IE-MACE) was higher in BAV-IE (96% [50/52] vs 64% [156/244]; P < 0.0001). Age (OR: 0.74, 95% CI: 0.59 to 0.92 per 10-years; P = 0.006), BAV(OR: 4.91; CI: 1.08-22.38; P = 0.04), and symptom-to-diagnosis time (OR: 1.23; CI: 1.09-1.38; P = 0.001 per week) were independently associated with IE-MACE. There was a linear 23% increase odds of IE-MACE per week of diagnosis delay. BAV-IE patients had superior 4-year survival but became similar after age and sex adjustment.

BAV-IE patients incur delayed symptom-to-diagnosis time resulting in high IE complication burden, despite predominance of less virulent streptococcal causative microorganisms. These findings call for enhanced IE clinical suspicion in BAV patients and suggest antibiotic prophylaxis may be indicated in these patients.