Korean J Intern Med.  2015 Jul;30(4):434-442. 10.3904/kjim.2015.30.4.434.

Infective endocarditis involving an apparently structurally normal valve: new epidemiological trend?

• Song JK

• KMID: 2366002
• DOI: http://doi.org/10.3904/kjim.2015.30.4.434

Abstract

Infective endocarditis (IE) has been increasingly diagnosed in patients without previously detected predisposing heart disease, but its clinical features have yet to be fully determined. A recent single-center study including echocardiographic images and surgical findings investigated the incidence of undiagnosed, clinically silent valvular or congenital heart diseases and healthcare-associated infective endocarditis (HAIE). The study confirmed that a large proportion of patients with IE have no previous history of heart disease. Analysis of underlying disease in these patients showed that undetected mitral valve prolapse was the most common disease, followed by an apparently structurally normal valve. The patients who developed IE of apparently structurally normal valves had different clinical characteristics and worse outcomes. IE involving a structurally normal valve was associated with both nosocomial and non-nosocomial HAIE, whereas community-acquired IE was more frequent than HAIE. The pathophysiologic mechanism involving the development of non-HAIE or community-acquired IE due to predominantly staphylococcal infection in an apparently structurally normal valve is not yet clearly understood. Structurally normal valves are not necessarily free of regurgitation or abnormal turbulence and, given the dynamic nature and fluctuating hemodynamic effects of conditions such as poorly controlled hypertension, end-stage renal disease, and sleep apnea, further investigation is necessary to evaluate the potential role of these diseases in the development of IE. An apparently normal-looking valve is associated with IE development in patients without previously recognized predisposing heart disease, warranting repartition of at-risk groups to achieve better clinical outcomes.

Keyword

Endocarditis; Echocardiography; Outcomes

MeSH Terms

Adult
Aged
Community-Acquired Infections/diagnosis/*epidemiology/microbiology/physiopathology/therapy
Cross Infection/diagnosis/*epidemiology/microbiology/physiopathology/therapy
Echocardiography, Doppler, Color
Endocarditis, Bacterial/diagnosis/*epidemiology/microbiology/physiopathology/therapy
Female
Heart Valves/*microbiology/physiopathology/ultrasonography
Humans
Incidence
Male
Middle Aged
Predictive Value of Tests
Prognosis
Risk Factors