Better prognosis of elderly patients with infectious endocarditis in the era of routine echocardiography and nonrestrictive indications for valve surgery

[Infective endocarditis in the elderly: The current view of the problem]

The review gives the current views of the etiology and risk factors of infective endocarditis (IE) in the elderly. It reports the specific clinical picture of the disease at this age, including clinically apparent syndromes, comorbidity, and various clinical signs and peculiarities of IE. Particular emphasis is placed on the diagnosis of an endocardial infectious lesion, which is based on the use of the modified Duke criteria. The methods of IE diagnosis, particularly microbiological examination, imaging techniques, among which echocardiography in different modes plays a particular role, are listed. The treatment of the disease is based on the latest recommendations for antibiotic therapy with and without regard to a specific etiological factor. The issues of surgical intervention, as well as approaches to preventing IE in elderly people are discussed.

[Infective endocarditis in patients with chronic liver disease: clinical and prognostic assessment]

INTRODUCTION AND OBJECTIVES

Chronic liver disease increases the susceptibility to bacterial infections and infective endocarditis. Our aim was to determine the clinical and microbiological features and the prognosis in patients with chronic liver disease who also had infective endocarditis.

PATIENTS AND METHOD

One hundred and seventy-four consecutive inpatients at our institution were recruited and followed. Thirty of them had chronic liver disease. Clinical, microbiological and echocardiographic variables were analyzed and, in some cases, histological variables were also recorded.

RESULTS

Patients with chronic liver disease were younger (36 11 vs 54 18 years; p < 0.01) and had a larger proportion of intravenous drug users (73 vs 16%; p < 0.01), HIV infection (47 vs 10%; p < 0.01), right valve involvement and spleen enlargement, but heart failure appeared less often (7 vs 34%; p = 0.003). Thirty percent of the patients with and 51% of patients without chronic liver disease underwent surgery for infective endocarditis. Total mortality among patients with and without chronic liver disease was 40% and 31%, respectively. After adjustment for age and for the incidence of congestive heart failure, chronic liver disease doubled mid-term mortality with a RR = 2.45 (p = 0.015).

CONCLUSIONS

Chronic liver disease has a significant impact on the prognosis in patients with infective endocarditis, and these patients should therefore be considered a high risk group.

Infective Endocarditis in Elderly Patients

Infective endocarditis (IE) in elderly patients is a serious disease with significant morbidity and mortality. IE presents unique diagnostic and therapeutic challenges in the elderly. A heightened index of suspicion is necessary due to the atypical presentations of IE among the elderly. Underlying degenerative valvular disease, mitral valve prolapse, and presence of a prosthetic valve are important predisposing risk factors for IE in the elderly. IE in the elderly is somewhat more common in men. The mitral valve is affected somewhat more frequently compared with the aortic valve. Streptococci and staphylococci are the predominant organisms, recovered in approximately 80% of elderly patients with IE. The presence of calcific valvular lesions and prosthetic valves often confound echocardiographic findings in the elderly. Aggressive diagnostic and therapeutic approaches are mandatory for a favorable outcome of IE in this group of patients.