A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology,Echocardiographic Imaging,Management, and Outcomes |
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| Authors: | Mohammad A. Zmaili Jafar M. Alzubi Duygu Kocyigit Agam Bansal Gursharan S. Samra Richard Grimm Brian P. Griffin Bo Xu |
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| Affiliation: | 1. Department of Medicine, Cleveland Clinic, Ohio;2. Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio;3. Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio;1. Division of General Internal Medicine, Geneva University Hospitals, Switzerland;2. Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland;3. Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland;4. Division of Angiology and Haemostasis, Geneva University Hospitals, Switzerland;1. Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander, Spain;2. Marqués de Valdecilla Health Research Institute (IDIVAL), Santander, Spain;3. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain;4. Radiology Department, Marqués de Valdecilla University Hospital, Santander, Spain;5. Pathological Anatomy Service, Marqués de Valdecilla University Hospital, Santander, Spain;1. Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel;2. Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel;1. DLR-German Aerospace Center, Institute for Aerospace Medicine, Cologne, Germany;2. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Germany;3. Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Germany;4. University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Germany |
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| Abstract: | BackgroundNonbacterial thrombotic endocarditis, or marantic endocarditis, is rare. Contemporary data on the etiology, echocardiographic evaluation, and management of nonbacterial thrombotic endocarditis are limited.MethodsA single-center retrospective cohort study was performed. Electronic medical records and echocardiographic records were searched for patients ages ≥18 years with a confirmed diagnosis of nonbacterial thrombotic endocarditis between January 1999 and November 2019. Demographic, echocardiographic, and management data were collected.ResultsOf 600,577 transthoracic echocardiograms (TTEs) and 89,264 transesophageal echocardiograms (TEEs), 42 patients had nonbacterial thrombotic endocarditis (mean age: 54 ± 14.5 years; 66.7% were female). The median duration of follow-up was 8.2 (interquartile range 3.3-24.4) months. Seventeen patients (40.5%) had malignancy, 33.3% had systemic lupus erythematosus, and 35.7% had antiphospholipid antibody syndrome. Stroke was the most common presentation (59.5%).TTE enabled the diagnosis in 19 cases (45.2%), compared with TEE, which identified the condition in 33 of 34 (97.1%) cases in which it was utilized. Three-dimensional echocardiography was performed in 17 TEEs. The most common valves involved were mitral (61.9%), and aortic (23.8%) valves. Thirty-two patients were managed with anticoagulation. Ten patients underwent surgery. Sixteen (38.1%) patients died, most of whom had a diagnosis of advanced malignancy.ConclusionIn a contemporary 20-year cohort, TTE and TEE played important roles in diagnosis, with superior diagnostic performance of TEE for nonbacterial thrombotic endocarditis. Mortality was high, and advanced malignancy portended a worse prognosis. Management in most cases was therapeutic anticoagulation. In select cases, surgery provided favorable outcomes. |
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| Keywords: | Anticoagulation Echocardiography Malignancy Marantic endocarditis Nonbacterial thrombotic endocarditis Systemic lupus erythematosus |
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