Original Investigation
Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse

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Abstract

Background

There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions.

Objectives

This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions.

Methods

This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89).

Results

BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients.

Conclusions

IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.

Key Words

antibiotic prophylaxis
bicuspid aortic valve
endocarditis
mitral valve prolapse

Abbreviations and Acronyms

AHA
American Heart Association
BAV
bicuspid aortic valve
CHD
congenital heart disease
ESC
European Society of Cardiology
HF
heart failure
IE
infective endocarditis
IEAP
infective endocarditis antibiotic prophylaxis
IQR
interquartile range
MVP
mitral valve prolapse
VGS
viridans group streptococci

Cited by (0)

This work was supported in part by the Instituto de Salud Carlos III (grants RD012/0042/0066 and CB16/11/00432). Dr. Miro received a personal 80:20 research grant from the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain during 2017 to 2019. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness and the ProCNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Grants from the Instituto de Salud Carlos III and the Spanish Ministry of Economy and Competitiveness are supported by the Plan Estatal de I+D+I 2013-2016—European Regional Development Fund “A way of making Europe.” The funders played no role in the design, collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Bernard Prendergast, BMedSChi, BM BS, DM, served as Guest Editor for this paper.

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