Kahrovic Amila, Angleitner Philipp, Herkner Harald, Werner Paul, Andreeva Alexandra, Poschner Thomas, Laengle Severin, Kocher Alfred, Laufer Guenther, Andreas Martin
Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2024 Sep 25;13(19):5712. doi: 10.3390/jcm13195712.
This study aimed to compare the clinical outcomes of mechanical and biological valve prostheses in patients with infective endocarditis presenting with stroke. Ninety-five adults with infective endocarditis complicated by stroke at baseline who underwent aortic and/or mitral valve replacement were analyzed retrospectively. The primary outcome was a composite outcome of all-cause mortality, ischemic stroke, hemorrhagic stroke, and re-endocarditis. Secondary outcomes included the individual components of the composite outcome and modified Rankin scale deterioration during follow-up. Among the study cohort, 34 patients (35.8%) received mechanical valve prostheses and 61 (64.2%) received biological valve prostheses. Implantation of a mechanical valve prosthesis seems to be associated with a decreased risk of attaining the composite outcome (adjusted HR 0.46, 95% CI 0.22-0.96, and = 0.037). Analyses of the individual components of the composite outcome showed that implantation of a mechanical valve prosthesis might not be associated with an increased risk of ischemic stroke, hemorrhagic stroke, and all-cause mortality during the follow-up period. Further, the risk of re-endocarditis was significantly lower in recipients of a mechanical valve prosthesis (adjusted HR 0.15, 95% CI 0.06-0.77, = 0.026). Notably, a trend toward decreased risk of modified Rankin scale deterioration throughout the follow-up period was observed in this group (adjusted odds ratio 0.22, 95% CI 0.05-1.02, = 0.053). Implantation of mechanical valve prostheses in patients presenting with infective endocarditis complicated by stroke seems to be beneficial in terms of a reduced risk of experiencing a composite outcome. Analyses of larger cohorts are required to validate our findings.
本研究旨在比较感染性心内膜炎合并卒中患者使用机械瓣膜假体和生物瓣膜假体的临床结局。对95例基线时患有感染性心内膜炎并合并卒中且接受主动脉瓣和/或二尖瓣置换术的成年人进行了回顾性分析。主要结局是全因死亡率、缺血性卒中、出血性卒中和再发性心内膜炎的复合结局。次要结局包括复合结局的各个组成部分以及随访期间改良Rankin量表恶化情况。在研究队列中，34例患者（35.8%）接受了机械瓣膜假体，61例患者（64.2%）接受了生物瓣膜假体。植入机械瓣膜假体似乎与获得复合结局的风险降低相关（调整后HR为0.46，95%CI为0.22 - 0.96，P = 0.037）。对复合结局各个组成部分的分析表明，植入机械瓣膜假体在随访期间可能与缺血性卒中、出血性卒中和全因死亡率风险增加无关。此外，机械瓣膜假体接受者发生再发性心内膜炎的风险显著更低（调整后HR为0.15，95%CI为0.06 - 0.77，P = 0.026）。值得注意的是，在该组中观察到整个随访期间改良Rankin量表恶化风险有降低趋势（调整后比值比为0.22，95%CI为0.05 - 1.02，P = 0.053）。对于感染性心内膜炎合并卒中的患者，植入机械瓣膜假体在降低复合结局风险方面似乎是有益的。需要对更大的队列进行分析以验证我们的发现。
