Key result
BAV and MVP show ~3-fold higher viridans streptococcal endocarditis rates than other risk groups.
Why the study?
Little information existed regarding infective endocarditis in patients with bicuspid aortic valve or mitral valve prolapse, for whom antibiotic prophylaxis is currently not recommended.
Cohort (n=3,208)
Yes
Absolute Event Rate: 35.2% vs 12.1%
p-value: p=<0.01
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The Zegri-Reiriz et al study is the largest series to date regarding IE in BAV and MVP patients. Participants were relatively young, male, and had few comorbidities. However, these participants exhibited cardiovascular complications at rates similar to patients with high-risk conditions (BAV, 50%; MVP, 47%; high risk, 45%) and significantly higher than low/moderate-risk IE patients.”
“The findings from the Spanish study evidenced the uniquely high in-hospital IE associated fatality rates suffered by patients having bicuspid aortic valves (BAV); 5.6% or mitral valve prolapse (MVP); 10%.”
Patients with bicuspid aortic valve or mitral valve prolapse who develop infective endocarditis have higher rates of viridans group streptococci and odontologic origin with intracardiac complication rates similar to high-risk patients, suggesting antibiotic prophylaxis recommendations should be reconsidered for these groups.
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.
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Zegrí‐Reiriz et al. (2018) conducted a cohort in Infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP) (n=3,208). Bicuspid aortic valve (BAV) or mitral valve prolapse (MVP) vs. High-risk IE with antibiotic prophylaxis indication and low/moderate-risk IE without indication was evaluated on Incidence of viridans group streptococci infective endocarditis (p=<0.01). Bicuspid aortic valve and mitral valve prolapse patients with IE had higher rates of viridans group streptococci than high- and low/moderate-risk groups (35.2% and 39.3% vs 12.1% and 15.0%; p<0.01).
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