Clinical and Echocardiographic Features of Patients With Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology

Rossella Maria Benvenga, Christophe Tribouilloy, Hector I. Michelena, Angelo Silverio, Florent Arregle, Hélène Martel, Seyhan Denev, Yohann Bohbot, Sandrine Hubert, Sébastien Renard, Laurence Camoin, Anne Claire Casalta, Jean Paul Casalta, Frédérique Gouriet, Alberto Riberi, Hubert Lepidi, Frederic Collart, Didier Raoult, Michel Drancourt, Gennaro GalassoDaniel C. DeSimone, Rodolfo Citro, Gilbert Habib

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The influence of different bicuspid aortic valve (BAV) morphology in the clinical course of infective endocarditis (IE) has not yet been investigated. This study aimed to describe the clinical and echocardiographic features of IE in patients with BAV (BAVIE) according to valve morphology. Methods: Patients with definite BAVIE prospectively enrolled in 4 high-volume referral centers from 2000 to 2019 were evaluated and divided into 2 groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right noncoronary or left noncoronary (non-RL type) cusp fusion. All patients were followed up for 1 year. Results: One hundred thirty-eight patients with BAVIE were included (77.7% male; median age, 52 [36.83-61.00] years): 112 patients with RL type (81%) and 26 patients with non-RL type BAV (19%), with no significant differences in age, sex, and comorbidities between groups. Although 43% of the cohort had known BAV, the referral was late after symptom onset, particularly for the RL phenotype; time from symptom onset to hospitalization >30 days (31.3% vs 11.5%; P = .032) and New York Heart Association class ≥ II (64.3% vs 42.3%; P = .039) were more frequent in patients with RL type BAV than in patients with non-RL type BAV. Conversely, patients with non-RL type BAV had a higher incidence of hemorrhagic stroke (19.2% vs 5.4%; P = .034) and high-grade atrioventricular block (11.5% vs 0.9%; P = .021). Streptococcus viridans was more frequently isolated in patients with non-RL type BAV than in patients with RL type BAV (44% vs 24.1%; P = .045). No difference in short- and intermediate-term mortality was observed between groups. Conclusions: Clinical profile and echocardiographic features in BAVIE patients may differ according to valve morphology, and patients with BAVIE appear to be referred late, even when BAV disease is previously known.

Original languageEnglish (US)
Pages (from-to)760-768
Number of pages9
JournalJournal of the American Society of Echocardiography
Volume36
Issue number7
DOIs
StatePublished - Jul 2023

Keywords

  • Bicuspid aortic valve
  • Infective endocarditis
  • Valve disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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