二叶式主动脉瓣患者的感染性心内膜炎：临床特征、并发症及预后

Infective endocarditis in patients with bicuspid aortic valve: Clinical characteristics, complications, and prognosis.

作者信息

Becerra-Muñoz Víctor M, Ruíz-Morales Josefa, Rodríguez-Bailón Isabel, Sánchez-Espín Gemma, López-Garrido Miguel A, Robledo-Carmona Juan, Guijarro-Contreras Ana, García-López María Victoria, Ivanova-Georgieva Rada, Mora-Navas Laura, Gómez-Doblas Juan José, de Teresa-Galván Eduardo

机构信息

UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.

UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España.

出版信息

Enferm Infecc Microbiol Clin. 2017 Dec;35(10):645-650. doi: 10.1016/j.eimc.2016.06.017. Epub 2016 Aug 1.

DOI:10.1016/j.eimc.2016.06.017

PMID:27493083

Abstract

INTRODUCTION

Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. It is associated to a higher risk of cardiovascular complications, including infective endocarditis (IE).

METHODS

Retrospective, observational and single centre study that included all patients with IE diagnosed between 1996 and 2014. An analysis was made of the epidemiological, clinical, microbiological and echocardiographic data, complications during hospital admission, need for surgery, in-hospital mortality, and 1-year follow-up. Cases with endocarditis on prosthetic valves or other locations were excluded, as well as those for which the aortic valve morphology had not been accurately defined. A comparative statistical analysis was performed between BAV and tricuspid (TAV).

RESULTS

Of a total of 328 cases with IE, 118 (35.67%) were on aortic valve, with 18 (16.22%) of them being BAV. The BAV cases were younger than TAV (51±19.06 vs. 60.83±15.73 years, P=.021) and they had less comorbidity (Charlson 0.67±0.77 vs. 1.44±1.64, P=.03).). There was a higher tendency of Staphylococcal origin (38.9 vs. 21.5%, P=.137), and 55.6% showed peri-valvular complications (TAV 16.1%, P=.001), in particular, abscesses (38.9 vs.16.1%, P=.047). BAV was the only predictive factor of peri-valvular complications (OR 7.87, 95% CI; 2.38-26.64, P=.001). Patients with BAV had more surgery during their admission (83.3 vs. 44.1%, P=.004), had less in-hospital mortality, with no statistical significance (5.6 vs. 25.8%, P=.069), and 1-year survival was significantly superior (93.8 vs 69.3%, P=.048).

CONCLUSIONS

Patients with IE on BAV are young, with low comorbidity. They frequently present with peri-valvular complications and they often require early surgery. Compared to TAV cases, in-hospital mortality is lower and 1-year survival is significantly higher.

摘要

引言

二叶式主动脉瓣（BAV）是最常见的先天性心脏病。它与心血管并发症的较高风险相关，包括感染性心内膜炎（IE）。

方法

一项回顾性、观察性单中心研究，纳入了1996年至2014年间诊断为IE的所有患者。对流行病学、临床、微生物学和超声心动图数据、住院期间的并发症、手术需求、住院死亡率及1年随访情况进行了分析。排除人工瓣膜或其他部位的心内膜炎病例，以及主动脉瓣形态未准确界定的病例。对BAV和三叶式主动脉瓣（TAV）进行了比较统计分析。

结果

在总共328例IE病例中，118例（35.67%）累及主动脉瓣，其中18例（16.22%）为BAV。BAV病例比TAV病例年轻（51±19.06岁对60.83±15.73岁，P = 0.021），且合并症较少（Charlson评分为0.67±0.77对1.??±1.64，P = 0.03）。葡萄球菌来源的倾向更高（38.9%对21.5%，P = 0.137），55.6%的患者出现瓣周并发症（TAV为16.1%，P = 0.001），尤其是脓肿（38.9%对16.1%，P = 0.047）。BAV是瓣周并发症的唯一预测因素（比值比7.87，95%置信区间；2.38 - 26.64，P = 0.001）。BAV患者住院期间接受手术的比例更高（83.3%对44.1%，P = 0.004），住院死亡率较低，但无统计学意义（5.6%对25.8%，P = 0.069），1年生存率显著更高（93.8%对69.3%，P = 0.048）。