Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
S Afr Med J. 2022 Apr 4;112(4):13554.
Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. The prevalence of PVE in South African retrospective studies ranges between 13% and 17%.
To define the clinical profile and outcomes of patients with PVE, and compare them with those of native valve endocarditis (NVE) patients.
We performed a prospective observational study of patients presenting or referred to Groote Schuur Hospital, Cape Town, with definite or possible infective endocarditis (IE) based on the 2015 European Society of Cardiology IE diagnostic criteria. Consenting adult patients who met the inclusion criteria were enrolled into the Groote Schuur Hospital Infective Endocarditis Registry, which was approved by the University of Cape Town Human Research Ethics Committee. This study is an analysis of the patients enrolled between 1 January 2017 and 31 December 2019.
During the study period, a total of 135 patients received a diagnosis of possible or definite IE (PVE n=18, NVE n=117). PVE therefore accounted for 13.3% of the overall IE cohort. PVE patients had a mean (standard deviation) age of 39.1 (14.6) years, and 56.6% were male. PVE occurred within 1 year of valve surgery in 50.0% of cases. Duke's modified diagnostic criteria for definite IE were met in 94.4% of the PVE cohort. Isolated aortic valve PVE was present in 33.3%, and a combination of aortic and mitral valve PVE in 66.6%. Tissue prosthetic valves were affected in 61.1% of cases. Of the PVE cases, 55.6% were healthcare associated. On transthoracic echocardiography, vegetations (61.1%), prosthetic valve regurgitation (44.4%) and abscesses (22.2%) were discovered. Staphylococcus and Streptococcus species accounted for 38.8% and 22.2% of PVE cases, respectively, and 27.8% of cases were blood culture negative. Valve surgery was performed in 38.7% of the PVE patients, and 55.6% of the patients died during the index hospitalisation. Secondary analysis indicated that the PVE patients were sicker than those with NVE, with a higher frequency of septic shock and atrioventricular block (22.2% v. 7%; p=0.02 and 27.8% v. 12%; p=0.04, respectively). In addition, in-hospital mortality was higher in PVE patients than NVE patients (55.6% v. 31.6%; p=0.04).
PVE was uncommon, mainly affecting tissue prosthetic valves and prosthetic valves in the aortic position. Patients with PVE were sicker than those with NVE and had high in-hospital mortality.
人工瓣膜感染性心内膜炎（PVE）与较高的发病率和死亡率相关。南非回顾性研究中 PVE 的患病率在 13%至 17%之间。
定义 PVE 患者的临床特征和结局，并将其与原发性瓣膜心内膜炎（NVE）患者进行比较。
我们对 2015 年欧洲心脏病学会心内膜炎诊断标准确诊或疑似感染性心内膜炎（IE）的开普敦格罗特舒尔医院就诊或转来的患者进行了前瞻性观察性研究。符合纳入标准的成年患者同意入组格罗特舒尔医院感染性心内膜炎登记处，该登记处获得了开普敦大学人类研究伦理委员会的批准。本研究分析了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间入组的患者。
在研究期间，共有 135 例患者被诊断为可能或明确的 IE（PVE n=18，NVE n=117）。因此，PVE 占 IE 患者总数的 13.3%。PVE 患者的平均（标准差）年龄为 39.1（14.6）岁，56.6%为男性。50.0%的 PVE 患者在瓣膜手术后 1 年内发生 PVE。94.4%的 PVE 患者符合 Duke 改良的明确 IE 诊断标准。单纯主动脉瓣 PVE 占 33.3%，主动脉瓣和二尖瓣联合 PVE 占 66.6%。组织人工瓣膜受累占 61.1%。PVE 中有 55.6%为医源性感染。经胸超声心动图发现赘生物（61.1%）、人工瓣膜反流（44.4%）和脓肿（22.2%）。葡萄球菌和链球菌分别占 PVE 病例的 38.8%和 22.2%，27.8%的病例血培养阴性。38.7%的 PVE 患者接受了瓣膜手术，55.6%的患者在住院期间死亡。二次分析表明，PVE 患者比 NVE 患者病情更严重，感染性休克和房室传导阻滞的发生率更高（22.2%比 7%；p=0.02 和 27.8%比 12%；p=0.04）。此外，PVE 患者的院内死亡率高于 NVE 患者（55.6%比 31.6%；p=0.04）。
PVE 并不常见，主要影响组织人工瓣膜和主动脉位置的人工瓣膜。PVE 患者比 NVE 患者病情更严重，院内死亡率更高。
