Risk groups for latent infective endocarditis in patients with aortic stenosis
Introduction. Despite advances in the diagnosis and treatment of infective endocarditis (IE), morbidity and mortality rates remain high. The group of patients with latent IE is of particular interest. Objective: To identify risk groups for latent IE in patients with aortic stenosis (AS) and determine the specific management options for this group of patients. Material and methods. A retrospective analysis of 313 medical records of patients with moderate to severe AS who underwent aortic valve replacement was made. 144 patients were diagnosed with latent IE (study group) and 169 without this diagnosis (comparison group). Results. Patients without IE were younger than those in the study group (p <0.0001) and had a significantly lower prevalence of arterial hypertension (AH) (81.1% vs. 85.4%, p = 0.034) and atrial fibrillation (AF) (18.3% vs. 29.2%, p = 0.019). Aortic valve and blood cultures yielded microbial growth in only 6% of cases, in the majority of cases Staphilococcus growing was fixed. The majority of patients with latent IE (88%) received antibacterial therapy (ABT), with a median duration of 14 (14; 21) days. Single-drug ABT was administered to 71.6% of patients, primarily it was ampicillin/sulbactam variant. Thus, AH and AF were more frequently recorded in the study group of patients with latent IE. The higher prevalence of AH is presumably associated with older age, while the presence of AF, in addition to age, is taking place likely due to the underlying inflammatory process. The combination of these three factors led to more pronounced left ventricular remodeling in the main study group. Conclusion. The results of the study allowed us to verify the phenotypic peculiarities of patients with latent IE and AS. Due to the low detection rate of IE causative agent, empirical ABT was administered in the overwhelming majority of cases. Given this, further identification of risk factors for the development of latent IE and the development and implementation of new methods for IE pathogen verification are required to improve treatment outcomes and reduce early and late complications.M.V. Gorkin, U.M. Shadrina, M.A. Korzhova, E.A. Guryanova, V.I. Dzhum, L.B. Mitrofanova, O.B. Irtyuga
Keywords
endocarditis
latent infective endocarditis
aortic stenosis
antibacterial therapy
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About the Authors
Maksim V. Gorkin, MD, senior laboratory assistant at the Department of cardiology, faculty of postgraduate and continuing education of the Institute of medical education, V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.E-mail: m-gorkin@list.ru
ORCID: https://orcid.org/0009-0004-5848-0470. eLibrary SPIN: 9985-9625
Ulyana M. Shadrina, MD, junior researcher at the research laboratory for congenital and acquired heart defects, cardiologist at V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
E-mail: u-shadrina@mail.ru
ORCID: https://orcid.org/0000-0002-7259-1546. Scopus ID: 58660281900. eLibrary SPIN: 4656-632
Maria A. Korzhova, MD, first-year clinical resident of the Department of cardiology, faculty of postgraduate and continuing education of the Institute of medical education, V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
E-mail: Korzhova-maria@mail.ru
ORCID: https://orcid.org/0009-0004-2084-2093. eLibrary SPIN: 8828-8640
Elizaveta A. Guryanova, fifth-year student of the Faculty of general medicine of the Institute of medical education, V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
E-mail: guryanova_ea@almazovcentre.ru
Victoria I. Dzhum, MD, cardiologist at V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
E-mail: dzhum_vi@almazovcentre.ru
ORCID: https://orcid.org/0009-0000-5778-6954
Lyubov B. Mitrofanova, MD, Dr. Sci. (Medicine), professor, head of the Department of pathological anatomy and clinic of the Institute of medical education, head of the pathomorphology service, pathologist of the highest category of the Department of pathology of the University clinic, V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
E-mail: lubamitr@yandex.ru
ORCID: https://orcid.org/0000-0003-0735-7822. Scopus ID: 6603104513. eLibrary SPIN: 9552-8248
Olga B. Irtyuga, MD, Dr. Sci.(Medicine), associate professor, professor of the Department of cardiology, faculty of postgraduate and continuing education, deputy director for clinical work, Institute of medical education; head of the research laboratory of congenital and acquired heart defects, cardiologist at V.A. Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
E-mail: olgir@yandex.ru
ORCID: https://orcid.org/0000-0002-8656-3191. Scopus ID: 56293743500. eLibrary SPIN: 3187-8554
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