Quintero-Martinez Juan A, Hindy Joya-Rita, El Zein Said, Michelena Hector I, Nkomo Vuyisile T, DeSimone Daniel C, Baddour Larry M
Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Heart. 2022 May 9. doi: 10.1136/heartjnl-2022-320970.
Non-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients.
Adults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up.
Forty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively).
NBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.
非细菌性血栓性心内膜炎（NBTE）是一种由于非感染机制导致心脏瓣膜赘生物和/或增厚的综合征。如今，基于超声心动图检查结果，NBTE在生前即可诊断。因此，为了更好地描述这种疾病，我们对这些患者的流行病学、人口统计学、诊断及临床结局进行了当代综述。
纳入2014年12月至2021年12月在梅奥诊所企业内确诊为NBTE的成人患者。NBTE诊断由至少包括心脏病学、传染病学、风湿病学和肿瘤学在内的两个专科的临床医生确定。血培养阳性、感染性心内膜炎、培养阴性心内膜炎及拒绝研究授权的患者被排除。所有患者均进行了1年的随访。
共确定48例病例；平均年龄为60.0±13.8岁，75%为女性。最常见的合并症是恶性肿瘤（52.1%）和结缔组织病（37.5%）。瓣膜异常包括41例（85.4%）有赘生物的患者、43例（89.6%）有增厚的患者和26例（54.2%）有中至重度反流的患者。38例（79.2%）患者在NBTE诊断后1个月内发生栓塞事件（26例（54.2%）患者发生中风），16例（33.3%）患者在NBTE诊断后1年内死亡。转移性肿瘤和肺癌与1年全因死亡率相关（分别为p=0.0017和p=0.0004）。
NBTE在女性中更为常见，栓塞并发症是最常见的临床发现。总体而言，NBTE患者预后较差，尤其是肺癌或转移性肿瘤患者。鉴于其发病率和死亡率，需要对NBTE患者进行进一步研究。
