Clinical characteristics of left-sided infective endocarditis without underlying valvular heart diseases
Objective To investigate the clinical characteristics of left-sided infective endocarditis(IE)without underlying valvular heart diseases(VHD).Methods This was a retrospective study.Clinical data of 206 patients with left-sided IE(age:(50.4±16.1)years;144 males(69.9％))discharged from Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2011 to May 2021 were retrospectively analyzed,including 129 cases with underlying VHD(IE+VHD group)and 77 cases without underlying VHD(IE group).The 6-month survival rate of patients after discharge was analyzed with Kaplan-Meier survival curve;and the 6-month survival rates of the patients with different sizes of endocardial vegetation and different treatment modalities in the IE group were further analyzed with log-rank method.Results The proportions of patients with age ≥65 years old,arrhythmia and aortic valve involvement,and the in-hospital mortality in the IE group were significantly lower than those in the IE+VHD group(P＜0.05).However,the proportion of patients with fever and speech vague/limb movement disorder/headache,those with mitral valve involvement in the IE group were significantly higher than those in the IE+VHD group(P＜0.05).The median value of C-reactive protein(CRP)in the IE group was significantly higher than that in the IE+VHD group(P＜0.05).Nevertheless,the median value of N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the IE group was significantly lower than that in the IE+VHD group(P＜0.05).There were as no significant differences in the positive rates of bacterial/fungal blood cultures and the proportion of patients with mitral and aortic valve involvement of endocardial vegetation between the two groups(all P＞0.05).Kaplan-Meier survival curve analysis showed that there was no significant difference in 6-month survival rate of patients between the IE group and IE+VHD group(88.7％vs.93.6％,log-rank x2=0.887,P=0.346).In the IE group,the 6-month survival rate after discharge in patients with maximum diameter of vegetation ≤10 mm was higher than that in patients with maximum diameter of vegetation＞10 mm(96.3％vs.80.7％,log-rank x2=4.111,P=0.043).There was no significant difference in 6-month survival rate between patients treated with antibiotics combined with surgery and those treated with antibiotics alone(96.2％vs.78.6％,log-rank x2=2.976,P=0.084).Conclusion Compared to left-sided IE patients with underlying VHD,patients without underlying VHD are likely to have a younger age,more mitral valve involvement and lower in-hospital mortality;for those patients with maximum diameter of vegetation ≤10 mm there is a higher survival rate,and antibiotics combined with surgery may help to improve the survival rate.
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