南非感染性心内膜炎的超声心动图特征：一项前瞻性队列研究。

Echocardiographic features of infective endocarditis in South Africa: A prospective cohort study.

机构信息

Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

出版信息

S Afr Med J. 2022 Apr 30;112(5):321-327.

PMID:35587244

Abstract

BACKGROUND

Historically, infective endocarditis (IE) in South Africa (SA) was associated with the viridans group of streptococci affecting patients with underlying rheumatic heart disease (RHD). A changing IE bacteriological profile raises the question of whether the profile of underlying valvular abnormality has changed.

OBJECTIVES

To investigate the prevalence of underlying structural valve abnormalities and their aetiologies associated with IE in SA, and describe the typical imaging findings.

METHODS

The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and April 2021. Patients underwent detailed transthoracic and transoesophageal echocardiography to assess their underlying cardiac and valvular structure.

RESULTS

Among 71 patients included, a predisposing endocardial abnormality was detected in 49.3%, with RHD the most common single identifiable aetiology (16.9%). The in-hospital mortality rate was similar in patients with and without a predisposing endocardial abnormality (20% v. 16.7%; p=0.72), as was the rate of embolic events (20% v. 27.2%; p=0.58). Significantly more patients with a predisposing endocardial abnormality had an indication for surgery (94.3% v. 69.4%; p<0.01). The viridans group of streptococci was more prevalent in patients with a predisposing endocardial abnormality (25.7% v. 2.7%; p<0.01). Left-sided linear vegetation size >10 mm was associated with an increased risk of in-hospital mortality (24% v. 5%; p=0.05).

CONCLUSION

We observed a marked decrease in the prevalence of RHD in this cohort of patients with IE. The viridans group of streptococci was an uncommon cause of IE in patients with no predisposing endocardial abnormality detected. The presence of a predisposing endocardial abnormality was not associated with an increased risk of in-hospital mortality or embolic events. Linear vegetation length >10 mm was associated with an increased risk of in-hospital mortality in patients with left-sided IE.

摘要

背景

在南非（SA），感染性心内膜炎（IE）历史上与草绿色链球菌群相关，影响患有潜在风湿性心脏病（RHD）的患者。IE 细菌学特征的变化引发了一个问题，即潜在瓣膜异常的特征是否发生了变化。

目的

调查 SA 中与 IE 相关的潜在结构性瓣膜异常及其病因的流行情况，并描述典型的影像学发现。

方法

Tygerberg 心内膜炎队列研究前瞻性纳入 2019 年 11 月至 2021 年 4 月期间 IE 患者。患者接受详细的经胸和经食管超声心动图检查，以评估其潜在的心脏和瓣膜结构。

结果

在纳入的 71 名患者中，有 49.3%的患者存在潜在的心内膜异常，其中 RHD 是最常见的单一可识别病因（16.9%）。有和没有潜在心内膜异常的患者的住院死亡率相似（20%比 16.7%；p=0.72），栓塞事件发生率也相似（20%比 27.2%；p=0.58）。有潜在心内膜异常的患者中，有手术指征的患者明显更多（94.3%比 69.4%；p<0.01）。有潜在心内膜异常的患者中，草绿色链球菌更为常见（25.7%比 2.7%；p<0.01）。左侧线性赘生物大小>10mm 与住院死亡率增加相关（24%比 5%；p=0.05）。