Infective endocarditis in bicuspid aortic valve and mitral valve prolapse.

Abstract

Background: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) / mitral valve prolapse (MVP), and IE antibiotic prophylaxis (IEAP) is currently not recommended for these conditions. Objectives: 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 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 (VGS) IE than high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs 12.1% and 15%, respectively, all p<0.01). A similar pattern was seen for IE from suspected odontological origin (14.8% and 18% vs 5.8% and 6%, all p<0.01). BAV and MVP patients had more intracardiac complications than low/moderate-risk group (50% and 47.2% vs 30.6%, both p<0.01) and similar to high-risk group patients. Conclusions: IE in patients with BAV and MVP have higher rates of VGS IE and IE from suspected odontological 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.