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Heart 1998;80:276-280 ( September )
a Department of
Medicine II, Mainz University, Mainz, Germany, b Department of Pathology, Mainz University, c Department of Biostatistics,
Mainz University, d Department
of Cardiothoracic and Vascular Surgery, Mainz University, e Division of Cardiology, University of
Essen, Essen, Germany
Correspondence to: Dr I Kupferwasser, Adult Infectious Diseases, Harbor-UCLA Medical Center, Bldg RB-2; Second Floor, 1000 West Carson Street, Torrance, CA 90509, USA. email: kupferwasser{at}humc.edu
Accepted for publication 24 April 1998
Aim
To
compare the clinical and morphological characteristics of patients with
Streptococcus bovis endocarditis with those
of patients with endocarditis caused by other microorganisms.
Methods177
consecutive patients (Streptococcus bovis,
22; other streptococci, 94;
staphylococci, 44; other, 17) with definite
infective endocarditis according to the Duke criteria were included.
All patients underwent transthoracic and transoesophageal
echocardiography. In 88 patients, findings from surgery/necropsy were obtained.
ResultsS
bovis endocarditis was associated with older patients, with a
higher mortality (p = 0.04), and with a higher rate of cardiac surgery (p < 0.001) than other microorganisms, although embolic events were observed less often (p = 0.02). Pathological
gastrointestinal lesions were detected in 45% of the patients.
Multiple valves were affected in 68% of the patients with
S bovis endocarditis and in 20% of those
with other organisms (p < 0.001). Moderate or severe regurgitation
occurred more often in S bovis endocarditis than with other microorganisms (p = 0.05). When surgery or necropsy was performed, infectious myocardial infiltration of the left ventricle
was confirmed histopathologically in 36% of the patients with
S bovis endocarditis and in 10% of those
with other organisms (p = 0.002).
ConclusionsS
bovis endocarditis is a severe illness because of the more
common involvement of multiple valves, and of the frequent occurrence of haemodynamically relevant valvar regurgitation and infectious myocardial infiltration.
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