Schünemann S, Werner G S, Schulz R, Bitsch A, Prange H W, Kreuzer H
Abteilung für Kardiologie und Pneumologie Georg-August-Universität.
Z Kardiol. 1997 Dec;86(12):1017-25. doi: 10.1007/s003920050144.
Embolic complications are a major prognostic determinant in the clinical course of infective endocarditis (IE) with an incidence of about 30-50%. In order to analyze risk factors leading to embolism in native (NVE) and prosthetic valve endocarditis (PVE), we reviewed 177 consecutive patients; 43% were female, 57% male, PVE occurred in 24% of all patients all left-sided, among the NVE were 11% right-sided IE. Major embolic complications occurred in 40% of all patients. In NVE, a higher rate of embolic events (45% vs. 26%; p < 0.05), and a larger vegetation size compared to PVE was observed (14 +/- 6 mm vs. 11 +/- 5 mm; p < 0.05). The most important risk factor for embolic complications in NVE was Staphylococcus aureus (odds ratio 6.4). Furthermore, double valve endocarditis, fever, and mitral valve endocarditis were associated with the risk for embolism. In case of severe regurgitation the rate of embolic complications was reduced (54% vs. 77%; p < 0.05). In PVE, fever was a risk factor for embolic events. Staphylococcus aureus was also a frequent microorganism in embolism (45% vs. 22%). The in-hospital mortality was significantly increased in case of embolism (NVE 40% vs. 11%; p < 0.001; PVE 36% vs. 9% p < 0.05). About 50% of all embolic events occurred before admission. In NVE, due to high in-hospital mortality, the rate of patients with embolism undergoing surgery was lower (57% vs. 72%; p < 0.05); whereas in PVE no significant difference was observed. In patients with NVE, aspirin therapy because of coronary artery disease appeared to reduce the rate of embolic complications (11% vs. 47%). However, the low number of patients on aspirin (9%) does not allow recommendations regarding a potential benefit. In conclusion, identification of risk factors leading to embolism in IE may be useful in considering early surgical therapy. However, the high rate of embolic complications before hospital admission indicates a need for improving the diagnostic delay in the prehospital phase.
栓塞并发症是感染性心内膜炎（IE）临床病程中的一个主要预后决定因素，发生率约为30%-50%。为了分析导致自体瓣膜心内膜炎（NVE）和人工瓣膜心内膜炎（PVE）发生栓塞的危险因素，我们回顾了177例连续病例；43%为女性，57%为男性，PVE发生于所有患者的24%，均为左侧病变，在NVE中，11%为右侧IE。40%的患者发生了严重栓塞并发症。在NVE中，观察到栓塞事件发生率更高（45%对26%；p<0.05），且赘生物大小比PVE更大（14±6mm对11±5mm；p<0.05）。NVE中栓塞并发症最重要的危险因素是金黄色葡萄球菌（比值比6.4）。此外，双瓣膜心内膜炎、发热和二尖瓣心内膜炎与栓塞风险相关。在存在严重反流的情况下，栓塞并发症发生率降低（54%对77%；p<0.05）。在PVE中，发热是栓塞事件的一个危险因素。金黄色葡萄球菌也是栓塞中常见的微生物（45%对22%）。发生栓塞时，住院死亡率显著增加（NVE为40%对11%；p<0.001；PVE为36%对9%，p<0.05）。约50%的栓塞事件发生在入院前。在NVE中，由于住院死亡率高，接受手术的栓塞患者比例较低（57%对72%；p<0.05）；而在PVE中未观察到显著差异。在患有NVE的患者中，因冠状动脉疾病接受阿司匹林治疗似乎可降低栓塞并发症发生率（11%对47%）。然而，接受阿司匹林治疗的患者数量较少（9%），无法就潜在益处给出建议。总之，识别IE中导致栓塞的危险因素可能有助于考虑早期手术治疗。然而，入院前栓塞并发症的高发生率表明需要缩短院前阶段的诊断延迟时间。
