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Incidence and Predictors of Infective Endocarditis in Mitral Valve Prolapse: A Population-Based Study.

Abstract：

OBJECTIVE:To determine the incidence and predictors of infective endocarditis (IE) in a population-based cohort of patients with mitral valve prolapse (MVP). PATIENTS AND METHODS:We identified all adult Olmsted County residents with MVP diagnosed by echocardiography from January 1989 to December 1998 and cross-matched them with the Rochester Epidemiology Project-identified Olmsted County cases of IE from January 1, 1986, through December 31, 2006. We retrospectively analyzed and de novo confirmed each IE case using the modified Duke criteria. RESULTS:There were 896 Olmsted County residents with echocardiographically diagnosed MVP (mean age, 53±21 years; 565 women [63%]). The mean follow-up period was 11±5 years. The 15-year cohort risk of IE after MVP diagnosis was 1.1%±0.4% (incidence, 86.6 cases per 100,000 person-years; 95% CI, 43.3-173.2 cases per 100,000 person-years); thus, the age- and sex-adjusted relative risk of IE in patients with MVP was 8.1 (95% CI, 3.6-18.0) in comparison to the general population of Olmsted County (P<.001). There were no IE cases in patients without previously diagnosed mitral regurgitation (MR). Conversely, IE incidence was higher in patients with MVP with moderate, moderate-severe, or severe MR (289.5 cases per 100,000 person-years; 95% CI, 108.7-771.2 cases per 100,000 person-years; P=.02 compared with trivial, mild, or mild-moderate MR) and in patients with a flail mitral leaflet (715.5 cases per 100,000 person-years; 95% CI, 178.9-2861.0 cases per 100,000 person-years; P=.02 compared with no flail mitral leaflet). CONCLUSION:The population-based incidence of IE in adults with MVP is higher than those previously reported in case-control, tertiary care center studies. Patients with MVP and moderate, moderate-severe, or severe MR or a flail mitral leaflet are at a notable risk of developing IE in comparison with those without MR.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Katan O,Michelena HI,Avierinos JF,Mahoney DW,DeSimone DC,Baddour LM,Suri RM,Enriquez-Sarano M

doi

10.1016/j.mayocp.2015.12.006

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

336-42

issue

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(15)00994-5

journal_volume

pub_type

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Incidence and Predictors of Infective Endocarditis in Mitral Valve Prolapse: A Population-Based Study.