Pereira Sara Couto, Abrantes Ana Lobato, António Pedro Silverio, Morais Pedro, Sousa Catarina, David Cláudio, Pinto Fausto J, Almeida Ana G, Caldeira Daniel
Cardiology Department, Hospital Universitário de Santa Maria - CHULN, Portugal.
Centro Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal.
Int J Cardiol Heart Vasc. 2023 Jul 28;47:101249. doi: 10.1016/j.ijcha.2023.101249. eCollection 2023 Aug.
Antibiotic prophylaxis in bicuspid aortic valve patients is currently a matter of debate. Although it is no longer recommended by international guidelines, some studies indicate a high risk of infective endocarditis. We aim to evaluate the risk of native valve infective endocarditis in bicuspid aortic valve patients and compare to individuals with tricuspid aortic valve.
Study search of longitudinal studies regarding infective endocarditis incidence in bicuspid aortic valve patients (compared with tricuspid aortic valve/overall population) was conducted through OVID in the following electronic databases: MEDLINE, CENTRAL, EMBASE; from inception until October 2020. The outcomes of interest were the incidence rate and relative risk of infective endocarditis. The relative risk and incidence rate (number of cases for each 10 000 persons-year) with their 95 % confidence intervals (95 %CI) were estimated using a random effects model meta-analysis. The study protocol was registered at PROSPERO CRD42020218639.
Eight cohort studies were selected, with a total of 5351 bicuspid aortic valve patients. During follow up, 184 bicuspid aortic valve patients presented infective endocarditis, with an incidence rate of 48.13 per 10,000 patients-year (95 %CI 22.24-74.02), and a 12-fold (RR: 12.03, 95 %CI 5.45-26.54) increased risk compared with general population, after adjusted estimates.
This systematic review and meta-analysis suggests that bicuspid aortic valve patients have a significant high risk of native valve infective endocarditis. Large prospective high-quality studies are required to estimate more accurately the incidence of infective endocarditis, the relative risk and the potential benefit of antibiotic prophylaxis.
目前，二尖瓣主动脉瓣患者的抗生素预防问题存在争议。尽管国际指南不再推荐使用，但一些研究表明感染性心内膜炎风险较高。我们旨在评估二尖瓣主动脉瓣患者发生原发性瓣膜感染性心内膜炎的风险，并与三尖瓣主动脉瓣患者进行比较。
通过OVID在以下电子数据库中检索关于二尖瓣主动脉瓣患者（与三尖瓣主动脉瓣/总体人群相比）感染性心内膜炎发病率的纵向研究：MEDLINE、CENTRAL、EMBASE；从数据库建立至2020年10月。感兴趣的结局是感染性心内膜炎的发病率和相对风险。使用随机效应模型荟萃分析估计相对风险和发病率（每10000人年的病例数）及其95%置信区间（95%CI）。该研究方案已在PROSPERO注册，注册号为CRD42020218639。
选择了8项队列研究，共有5351例二尖瓣主动脉瓣患者。随访期间，184例二尖瓣主动脉瓣患者发生感染性心内膜炎，发病率为每10000患者年48.13例（95%CI 22.24 - 74.02），调整估计后与普通人群相比风险增加12倍（RR：12.03，95%CI 5.45 - 26.54）。
这项系统评价和荟萃分析表明，二尖瓣主动脉瓣患者发生原发性瓣膜感染性心内膜炎的风险显著较高。需要进行大规模前瞻性高质量研究，以更准确地估计感染性心内膜炎的发病率、相对风险以及抗生素预防的潜在益处。
