Werner G S, Schulz R, Fuchs J B, Andreas S, Prange H, Ruschewski W, Kreuzer H
Department of Cardiology, Georg-August-University, Goettingen, Germany.
Am J Med. 1996 Jan;100(1):90-7. doi: 10.1016/s0002-9343(96)90017-0.
Advanced age is considered to be associated with a more severe prognosis in infective endocarditis (IE), which is relevance in view of a change in epidemiology of the disease with an increasing proportion of elderly people. We wanted to examine whether in the era of improved diagnostic sensitivity for IE by transesophageal echocardiography the clinical course in elderly persons would be still more severe than in younger patients.
During the period from 1989 to 1993, 104 patients with 106 episodes of IE were treated at our university hospital. Three groups were compared: group A with 28 patients younger than 50 years, group B with 58 patients aged 50 to 70, and group C with 20 patients older than 70. Transesophageal echocardiography was performed in 78% of the patients; it was not performed in 22% of the patients with a conclusive transthoracic examination. The patients were followed up for an average of 25 months after the diagnosis.
No significant differences were observed among the age groups with respect to the possible source of infection, the frequency of positive blood cultures, and the type of infective organisms. Elderly patients more often had predisposing valvular conditions (eg, degenerative and calcified lesions and prosthetic valves), which decreased the sensitivity of transthoracic echocardiography to 45% as compared with 75% in group A. Transesophageal echocardiography improved the diagnostic yield by 45% in group C and by 47% in group B. Vegetations were smaller in group C and B as compared with group A, whereas other echocardiographic characteristics were similar. Fever and leukocytosis were less frequent in group C (55% and 25%, respectively) than in group A (82% and 61%, respectively). The interval between the onset of symptoms and the diagnosis of IE was similar in all groups. Elderly patients underwent surgical therapy as frequently (65%) as the other groups. The 1-year survival in group C (26%) was comparable with that in group A (22%) and group B (22%). The major determinant of survival was the occurrence of embolic complications.
Infective endocarditis in elderly patients caused less severe clinical symptoms than in young patients. The early diagnosis in elderly patients was facilitated by the high sensitivity of transesophageal echocardiography, which enabled the timely initiation of an appropriate medical and surgical therapy. This led to a clinical outcome similar to that for younger patients.
高龄被认为与感染性心内膜炎（IE）的预后更严重相关，鉴于该疾病流行病学的变化以及老年人比例的增加，这一点具有相关性。我们想研究在经食管超声心动图提高了IE诊断敏感性的时代，老年患者的临床病程是否仍比年轻患者更严重。
1989年至1993年期间，我校医院收治了104例患者，共发生106次IE发作。比较了三组：A组28例年龄小于50岁的患者，B组58例年龄在50至70岁之间的患者，C组20例年龄大于70岁的患者。78%的患者进行了经食管超声心动图检查；22%经胸检查确诊的患者未进行该检查。患者在诊断后平均随访25个月。
在感染可能来源、血培养阳性频率和感染生物体类型方面，各年龄组之间未观察到显著差异。老年患者更常存在易患瓣膜病（如退行性和钙化性病变以及人工瓣膜），这使得经胸超声心动图的敏感性降至45%，而A组为75%。经食管超声心动图使C组的诊断率提高了45%，B组提高了47%。与A组相比，C组和B组的赘生物较小，而其他超声心动图特征相似。C组发热和白细胞增多的发生率（分别为55%和25%）低于A组（分别为82%和61%）。所有组症状出现至IE诊断的间隔相似。老年患者接受手术治疗的频率（65%）与其他组相当。C组的1年生存率（26%）与A组（22%）和B组（22%）相当。生存的主要决定因素是栓塞并发症的发生。
老年患者的感染性心内膜炎引起的临床症状比年轻患者轻。经食管超声心动图的高敏感性有助于老年患者的早期诊断，从而能够及时开始适当的药物和手术治疗。这导致了与年轻患者相似的临床结果。
