Galzerano Domenico, Pergola Valeria, Kinsara Abdulhalim J, Vriz Olga, Elmahi Isra, Al Sergani Abdullah, Khaliel Feras, Cittadini Antonio, Di Giannuario Giovanna, Colonna Paolo
King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh; Alfaisal University, College of Medicine, Riyadh.
Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua.
Monaldi Arch Chest Dis. 2022 Apr 12;92(4). doi: 10.4081/monaldi.2022.2251.
The incidence of right-sided infective endocarditis (RSIE) is steadily increasing and it has been reported to be associated with high risk of embolic events (EE). Aim of our study was to identify the clinical characteristics of patients with RSIE complicated by PE. Indeed, the identification of patients at high risk of significant PE who will benefit from a more aggressive therapeutic strategy may improve the prognosis. From January 2015 to September 2020, 176 patients (Pts) in 6 centers were found to have definite RSIE complicated by PE. Advanced imaging for PE including computed tomography pulmonary angiography (CTPA) was performed in 28 pts (16%) who represent our study group (24 male, mean age 50.6 ±18.29 years). They all underwent transesophageal echocardiography (TEE), in 12 cases (43%) also three-dimensional (3D) TEE, and 27 patients (99%) had both TEE and transthoracic echocardiography (TTE). A total of 53 vegetations (V) were detected. In 18 pts (64%) two or more vegetations were found. Native tricuspid valve was the most frequently involved valve (38 V, 71.7%), followed by catheter (5 V, 9.4%), tricuspid valve prosthesis (4 V, 7.5%), chordae and papillary muscle (2 V, 3.8%) and one vegetation (9%) in each of the following: pulmonic valve, inferior vena cava, eustachian valve, and right atrium. The most common location for vegetations was the anterior leaflet of the tricuspid valve (19 V, 35.8 %) followed by the posterior leaflet (11 V, 20.8%). The most common vegetations morphology was raceme-like shaped (35.8%). Staphylococcus aureus (S. aureus) was the most common causative pathogen (14 pts, 50%). The incidence of PE was very high in patients with vegetation length above 1.5 cm (median 17.6±6.5 mm by TEE). Our results suggest that a routine CTPA should be advised in the presence of vegetations larger than 1.5 cm and with S. aureus infection. This behavior would identify patients at high risk of PE who will benefit from a more aggressive therapeutic strategy, leading to an improvement in the prognosis. Further prospective studies are required to better confirm our hypothesis.
右侧感染性心内膜炎（RSIE）的发病率正在稳步上升，据报道其与栓塞事件（EE）的高风险相关。我们研究的目的是确定合并肺栓塞（PE）的RSIE患者的临床特征。事实上，识别出那些将从更积极的治疗策略中获益的有显著PE高风险的患者，可能会改善预后。2015年1月至2020年9月，6个中心的176例患者被发现患有合并PE的明确RSIE。28例患者（16%）接受了包括计算机断层扫描肺动脉造影（CTPA）在内的PE高级成像检查，这些患者构成了我们的研究组（24名男性，平均年龄50.6±18.29岁）。他们均接受了经食管超声心动图（TEE）检查，12例（43%）还接受了三维（3D）TEE检查，27例患者（99%）同时接受了TEE和经胸超声心动图（TTE）检查。共检测到53个赘生物（V）。18例患者（64%）发现有两个或更多赘生物。天然三尖瓣是最常受累的瓣膜（38个V，71.7%），其次是导管（5个V，9.4%）、三尖瓣人工瓣膜（4个V，7.5%）、腱索和乳头肌（2个V，3.8%），以下部位各有1个赘生物（9%）：肺动脉瓣、下腔静脉、欧氏瓣和右心房。赘生物最常见的位置是三尖瓣前叶（19个V，35.8%），其次是后叶（11个V，20.8%）。最常见的赘生物形态是葡萄串样（35.8%）。金黄色葡萄球菌（S. aureus）是最常见的致病病原体（14例患者，50%）。赘生物长度超过1.5 cm的患者中PE的发生率非常高（TEE测量的中位数为17.6±6.5 mm）。我们的结果表明，对于存在大于1.5 cm的赘生物且伴有金黄色葡萄球菌感染的患者，建议常规进行CTPA检查。这种做法将识别出有PE高风险且将从更积极的治疗策略中获益的患者，从而改善预后。需要进一步的前瞻性研究来更好地证实我们的假设。
