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[Changes in infectious endocarditis--analysis of a disease picture in the last decade]
H R Schön1, C J Fuchs, A Schömig
1I. Medizinische Klinik rechts der Isar, Technische Universität München.
Insights
This study on infective endocarditis found that early surgery significantly reduced mortality and improved functional class, especially for staphylococcus aureus cases. Early intervention is key for better outcomes in heart valve infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Context:
- Retrospective analysis of 51 patients with infective endocarditis from 1980-1989.
- Aortic valve involvement was most common (59%).
- Predisposing factors or related incidents were present in 92% of patients.
Purpose:
- To analyze trends, complications, and outcomes of infective endocarditis over a decade.
- To compare mortality and functional outcomes between surgical and medical management.
- To assess the impact of specific pathogens, like Staphylococcus aureus, on prognosis.
Summary:
- Streptococcus viridans was the most common pathogen, though its prevalence decreased, while Staphylococcus aureus showed a significant increase.
- Acute heart failure (69%) and arterial embolism (41%) were the primary early complications.
- Overall 6-month mortality decreased to 16% compared to the previous decade's 31%.
Impact:
- Early heart-valve replacement within 6 months significantly lowered mortality (10% vs. 24% for non-operated patients).
- Staphylococcus aureus endocarditis had a worse early prognosis (28.6% survival) compared to other types (80% survival).
- Surgically treated patients showed significant functional class improvement post-treatment compared to medically treated patients, with over 80% 5-year survival.
Abstract:
The following retrospective study analyzes 51 patients aged 45.8 +/- 11 years with infective endocarditis diagnosed from January 1, 1980-December 31, 1989. The aortic valve was mainly affected (59%). 92% of patients showed predisposing factors or a directly related incident. Positive blood cultures were found in 63% of patients. The dominating bacterium was streptococcus viridans (31%) with decreasing tendency compared to the previous decade, followed by staphylococcus aureus (22%) with significantly increasing tendency. Clinical and laboratory findings were not different from those of the previous decade. Main complications in the early period of disease turned out to be acute heart failure (69%) and arterial embolism (41%) which was dependent on the severity of disease. Mortality within the initial 6 months was significantly lower than in the previous decade (16% vs 31%). Patients undergoing heart-valve replacement within the first 6 months of disease (59%) had a mortality rate of 10%, which was significantly smaller than the 24% mortality rate of patients not being operated during the same period. Furthermore, patients with staphylococcus aureus endocarditis demonstrated a markedly worse early prognosis (6 month survival rate 28.6 +/- 17.2% vs 80.0 +/- 6.1% in patients with infective endocarditis other than staphylococcus aureus-related). Late mortality was not different in the above-mentioned subgroups with a 5-year survival of more than 80%. However, surgically treated patients significantly improved their functional class in the follow-up period over medically treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)