The long and short of vegetations in infective endocarditis

Vikram, Holenarasipur R.

doi:10.1586/14787210.5.4.529

Cited by 4 publications

(3 citation statements)

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“…Understanding the pathogenesis of vegetation formation helps delineate the effect of Staphylococcus species on vegetation size. Vegetation consists primarily of platelets and fibrin which deposit on the cardiac endothelium following some form of injury [ 3 , 4 ]. Staphylococcus and Streptococcus strains have been shown to enhance platelet aggregation more so than other pathogens, contributing to the faster growth of vegetations.…”

Section: Discussionmentioning

confidence: 99%

“…Areas of valvular coaptation, which are rough central areas on the surface of a valve, are most commonly affected, including the ventricular sides of aortic and pulmonic valves, and the atrial sides of mitral and tricuspid valves (Keifer). Endocardial damage attracts platelets and fibrin deposition to the site of injury, where the bacteria colonize, leading to the formation of infected vegetations [2][3][4]. The presence of vegetation, therefore, constitutes a major criterion as part of Duke's criteria in the diagnosis of infective endocarditis.…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Review of the Natural Progression of Cardiac Vegetation

Bhatia¹,

Asghar²,

Khan³

et al. 2022

Cureus

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Introduction: Infective endocarditis (IE) is a life-threatening condition with an annual mortality of up to 40%. Vegetations are the hallmark of IE, however, factors that affect the initial size and changes in size remain unclear. Our study aims to investigate the natural history of cardiac vegetation, including changes in size and/or resolution with adequate treatment, and to analyze factors that influence size and potential for persistence.Material and methods: We conducted a retrospective review of 102 patients admitted with native-valve endocarditis at Henry Ford Health System from September 1, 2017, to June 30, 2019. We included patients treated with six weeks of intravenous antibiotics who had both a diagnostic and a follow-up echocardiogram after antibiotic completion.The primary outcome was the change in vegetation size. Secondary measures included pathogen identification, valve involvement, number of complications, associated IV drug use, and co-infection with hepatitis B/C. Results: Of the 102 patients reviewed, 30 patients matched the inclusion criteria. There was a significant decrease in vegetation size after adequate antibiotic treatment. However, complete resolution was not often seen. A statistically significant relationship was seen between vegetation size, IV drug use, and Staphylococcal species (including both methicillin-susceptible Staphylococcus aureus [MSSA] and methicillin-resistant S. aureus [MRSA]), whereas a history of hepatitis B or C was not significantly related to vegetation size. Conclusion: Large vegetation may predict a higher risk of embolic complications and can be reduced with IV antibiotics, although complete resolution is not likely. IV drug use and Staphylococcal endocarditis influence vegetation size and embolic complications. We argue that these subgroups should be prioritized for early surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Retrospective Review of the Natural Progression of Cardiac Vegetation

Bhatia¹,

Asghar²,

Khan³

et al. 2022

Cureus

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“…Large aortic valve vegetations are associated with a higher incidence of surgery and abscess formation in older patients with IE [ 7 , 8 ]. However, both the factors that influence the size of vegetation, when first detected, and the prognostic implications of the size of the vegetation have not been clearly determined [ 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding Bartonella-Associated Infective Endocarditis: Examining Heart Valve and Vegetation Appearance and the Role of Neutrophilic Leukocytes

Meidrops,

Groma,

Goldins

et al. 2023

Cells

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Background. The endocardium and cardiac valves undergo severe impact during infective endocarditis (IE), and the formation of vegetation places IE patients at a heightened risk of embolic complications and mortality. The relevant literature indicates that 50% of IE cases exhibit structurally normal cardiac valves, with no preceding history of heart valve disease. Gram-positive cocci emerge as the predominant causative microorganisms in IE, while Gram-negative Bartonella spp., persisting in the endothelium, follow pathogenic pathways distinct from those of typical IE-causing agents. Employing clinical as well as advanced microbiological and molecular assays facilitated the identification of causative pathogens, and various morphological methods were applied to evaluate heart valve damage, shedding light on the role of neutrophilic leukocytes in host defense. In this research, the immunohistochemical analysis of neutrophilic leukocyte activation markers such as myeloperoxidase, neutrophil elastase, calprotectin, and histone H3, was performed. A distinct difference in the expression patterns of these markers was observed when comparing Bartonella spp.-caused and non-Bartonella spp.-caused IE. The markers exhibited significantly higher expression in non-Bartonella spp.-caused IE compared to Bartonella spp.-caused IE, and they were more prevalent in vegetation than in the valvular leaflets. Notably, the expression of these markers in all IE cases significantly differed from that in control samples. Furthermore, we advocated the use of 16S rRNA Next-Generation Sequencing on excised heart valves as an effective diagnostic tool for IE, particularly in cases where blood cultures yielded negative results. The compelling results achieved in this study regarding the enigmatic nature of Bartonella spp. IE’s pathophysiology contribute significantly to our understanding of the peculiarities of inflammation and immune responses.

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