Abstract 14612: Infective Endocarditis in Patients Without Previous History of Cardiac Diseases: Clinical Features and Treatment Outcome
Retrospective analysis of clinical, laboratory and echocardiographic data of 241 consecutive patients with infective endocarditis (IE, age 51±17 years) showed that 131 (54.4n%) had no past medical history of cardiac diseases (group 1). Compared to patients with previous history of cardiac disease (group 2), patients in group 1 were characterized by higher prevalence of malignancy (OR 5.4, 95% CI1.5-19.1, p=0.01) and peripheral embolism not involving central nervous system (OR 1.8, 95% CI 1.1-3.3, p=0.02). Size and location of vegetation was not different between groups. Streptococcus viridans was the most common microorganism in both groups (35 vs 42%, p=0.291) and Staphyloccus aureus the second common (30 vs 19%, p=0.072). Underlying cardiac diseases in group 2 included previous valvular surgery (36%), ventricular septal defect (21%), mitral valve prolapse (15%) and rheumatic (12%) and degenerative (7%) valves. In group 1, vegetations involving normal looking valve was the most common (44%) and other lesions included mitral valve prolapse (25%), degenerative (9%) and rheumatic valve disease (7%). Staphylococcus aureus was more common causative agent in normal looking valve compared to other valvular diseases (45 vs 18%, p<0.001). The 6-month mortality was not different between the groups (76% vs 80%, p=0.361). In group 1, Staphylococcus aureus infection (HR 3.1, 95% CI 1.5-6.6, p=0.001), diabetes mellitus (HR 2.7, 95% CI 1.2-6.3, p=0.009), chronic kidney disease (HR=6.3, 95% CI 1.9-21.0, p=0.002) and liver cirrhosis (HR=5.2, 95% CI 1.8-14.4, p=0.002) were independent predictors for mortality. In group 2, Staphylococcus aureus infection (HR=2.8, 95% CI 1.1-7.2, p=0.02) was the only predictor.
Conclusions: In significant proportion of patients with IE, IE is the first clinical presentation without recognized cardiac diseases and they have different demographic features.
- © 2011 by American Heart Association, Inc.