[Infective endocarditis: the features of its clinical course and the prognosis].
The paper covers an investigation of 150 patients with infective endocarditis (IE), including 100 patients (aged 18 to 30 years old) with intravenous drug abuse as the main risk factor. This subgroup is characterized by an acute clinical course of IE, with tricuspid valve disorder in most cases and septic pulmonary embolism relapse in 72% of cases. Heart failure, multiple cardiac valvular disorder and focal lung destruction were found to be the main factors of unfavorable outcome. A relation between the size of vegetation on the heart valves and the mortality rate was established. At the same time, secondary immunodeficiency due to HIV-infection had no significant effect on the mortality rate in the group of drug addicts. More frequent cases of heart failure with systemic circulation embolism lead to higher hospital mortality in the group of patients with a subacute clinical course of IE. In elderly patients other concomitant pathology resulted in late IE detection and a high mortality rate.
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ABSTRACT: Background: Infective endocarditis is one of the most important complications of injection drug use, which is associated with significant mortality and morbidity. The aim of this study was to evaluate the influence of vegetation size and localization on outcome and in-hospital mortality of infective endocarditis. Patients and methods: A total of 34 patients were admitted to a university hospital in a four-year period and analyzed prospectively. Injection drug users were defined as patients who had injected drugs intravenously within the past 3 months before admission. The diagnosis of infective endocarditis was made on the basis of modified Duke's criteria. Results: Totally, 38 episodes of endocarditis in 34 patients were identified. Patients were all male with the mean (± standard deviation) age of 30.4±7.1 years. The affected valves were as follow: tricuspid valve in 26 cases (74.3%), mitral valve in 4 (11.4%), mitral and tricuspid valve in 4 (11.4%), and mitral and aortic valve in 1 (2.9%). The vegetation size was 10mm or less in 12 cases (34.29%), and more than 10mm in the remaining 23 cases (65.71%). Eight patients (21.1%) underwent surgery, however, unfortunately, nine (23.7%) died. Vegetations sized more than 10mm (p<0.033), involvement of the left-sided valves (p<0.012), and presence of more than one vegetation on TTE or TEE (p<0.05) were associated with higher probability of death. Conclusion: In contrast to some earlier studies which concluded that vegetations larger than 20mm are associated with higher mortality, our results revealed that the mortality rate increases even with smaller vegetations. In addition, the number and the location of vegetations also could affect the prognosis. Therefore, lower threshold for surgical interventions should be applied in patients with vegetations larger than 10mm.
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