San Martin Juan, Sarriá Cristina, de las Cuevas Carmen, Duarte Juan, Gamallo Carlos
Department of Internal Medicine, Infectious Disease Section, Hospital Universitario de la Princesa, Madrid, Spain.
J Heart Valve Dis. 2010 Jan;19(1):131-8.
The study aim was to describe the characteristics of prosthetic valve endocarditis (PVE) and the clinical presentation in relation to the period of diagnosis.
In this observational, prospective, multicenter study, data acquired from 100 consecutive cases of PVE were recorded. The period of diagnosis was defined as the time elapsed from valve implantation surgery to the PVE diagnosis. PVE was classified as early (EPVE) if diagnosed during the first eight weeks, intermediate (IPVE) from nine weeks to one year, and late (LVPE) if diagnosed after one year. Variables related to the period of diagnosis and causal microorganisms were compared using a chi-square test. A logistic regression analysis was made for any diagnosis delay greater than 15 days from the first symptoms, periannular extension, surgery, and death during hospitalization.
In total, data were collected from 24 patients with EPVE, 29 with IPVE, and 47 with LPVE. Some 59% of the IPVE episodes were caused by low-virulence microorganisms, compared to 29% of the EPVE episodes and 28% of the LPVE episodes (p = 0.017). Similarly, 66% of the IPVE episodes had a diagnosis delay longer than 15 days compared to 50% for LPVE and 20% for EPVE (p = 0.034), while 38% of the EPVE cases presented with fever and severe dyspnea compared to 10% of IPVE and 4% of LPVE cases (p = 0.001). In addition, 24% of the IPVE cases presented as fever and cardiac conduction disturbances, versus 4% for EPVE and 11% for LPVE (p = 0.08). When comparing EPVE with IPVE, the latter had a 69% periannular extension versus 38% for EPVE (p = 0.02) and 48% mortality versus 25%, respectively (p = 0.082). In a multivariate analysis, IPVE was related to the periannular extension of infection compared to EPVE (OR 3.4, 95% CI 0.98-12.1, p = 0.054). Death depended on the periannular extension of infection (OR 3.4, 95% CI 1.3-8.8, p = 0.011) and septic shock during hospitalization (OR 6.9, 95% CI 2.0-23.7, p = 0.002).
When diagnosed between nine weeks and one year after valve implantation, IPVE presented with low-grade clinical manifestations, a greater delay in diagnosis, a longer periannular extension and a poorer prognosis than did EPVE.
本研究旨在描述人工瓣膜心内膜炎（PVE）的特征以及与诊断时期相关的临床表现。
在这项观察性、前瞻性、多中心研究中，记录了连续100例PVE患者的数据。诊断时期定义为从瓣膜植入手术到PVE诊断所经过的时间。若在术后前八周内诊断为PVE，则归类为早期（EPVE）；若在九周后至一年内诊断为PVE，则归类为中期（IPVE）；若在一年后诊断为PVE，则归类为晚期（LPVE）。使用卡方检验比较与诊断时期和致病微生物相关的变量。对从首次出现症状起诊断延迟超过15天、瓣周扩展、手术以及住院期间死亡情况进行逻辑回归分析。
总共收集了24例EPVE患者、29例IPVE患者和47例LPVE患者的数据。约59%的IPVE发作由低毒力微生物引起，相比之下，EPVE发作中这一比例为29%，LPVE发作中为28%（p = 0.017）。同样，66%的IPVE发作诊断延迟超过15天，相比之下，LPVE为50%，EPVE为20%（p = 0.034），而38%的EPVE病例表现为发热和严重呼吸困难，相比之下，IPVE为10%，LPVE为4%（p = 0.001）。此外，24%的IPVE病例表现为发热和心脏传导障碍，相比之下，EPVE为4%，LPVE为11%（p = 0.08）。比较EPVE和IPVE时，后者瓣周扩展率为69%，而EPVE为38%（p = 0.02），死亡率分别为48%和25%（p = 0.082）。在多变量分析中，与EPVE相比，IPVE与感染的瓣周扩展相关（比值比3.4，95%置信区间0.98 - 12.1，p = 0.054）。死亡取决于感染的瓣周扩展（比值比3.4，95%置信区间1.3 - 8.8，p = 0.011）以及住院期间的感染性休克（比值比6.9，95%置信区间2.0 - 23.7，p = 0.002）。
与EPVE相比，在瓣膜植入后九周和一年之间诊断出的IPVE临床表现较轻，诊断延迟更长，瓣周扩展更长，预后更差。
