Objective

Endocarditis is increasing in incidence due to growing numbers of cardiac interventions, valve replacements and immunosuppressants. It can be difficult to diagnose clinically, has high mortality and can present as sudden cardiac death (SCD) with few/subtle preceding symptoms. True incidence of SCD related to endocarditis is unknown.

Methods

Retrospective analysis of UK national database of 6000 cases of SCD, 1994–2020, for “endocarditis” as cause of death.

Results

Of 30 cases (0.50%), 19(63%) were male and mean age was 36.2 ± 20.1 years. Postmortem examination showed the aortic valve was solely affected in 13 (43%), mitral in 9 (30%), tricuspid in 2(6.7%) and pulmonary in 1 (3.3%). Three cases (10%) had more than one valve affected and 2 (6.7%) were nonvalvular affecting the ascending aorta. Vegetations ranged from small easily missed irregularities to large fungating masses. Ten (33%) patients developed aortic abscesses, 2 of which had aneurysms, 13 (43%) had coronary artery septic emboli with micro-abscesses and myocardial microinfarction, and 2 (6.7%) were healed endocarditis with perforation and regurgitation with ventricular remodeling. Thirteen (43%) had an identifiable underlying valve abnormality or replacement, most common being a bicuspid aortic valve (7; 54%).

Conclusions

This study highlights that although rare, endocarditis is an important cause of SCD in those with normal valves, valvular disease and valve replacement surgery. Absence of a premortem diagnosis in 70% of our cohort highlights the need for detailed analysis of the heart and cardiac valves at autopsy. Gross appearance of vegetations varies widely and can be missed. Awareness of associated cardiac complications is required for elucidation of the cause of death and will provide valuable lessons for clinicians.

中文翻译：

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心内膜炎在心脏猝死中的作用：突出尸检，病理特征和心脏并发症的价值。

目的

心内膜炎的发生率由于心脏干预，瓣膜置换和免疫抑制剂的增加而增加。临床上可能难以诊断，死亡率高，并可能以很少或轻微的先前症状表现为心源性猝死（SCD）。与心内膜炎相关的SCD的真实发生率未知。

方法

回顾性分析1994-2020年英国国家数据库中6000例SCD的“心内膜炎”为死亡原因。

结果

在30例病例中（0.50％），男性19例（63％），平均年龄为36.2±20.1岁。死后检查显示，仅主动脉瓣受累13例（43％），二尖瓣受累9例（30％），三尖瓣受累2例（6.7％），肺部受累1例（3.3％）。3例（10％）的瓣膜受累超过1个，非瓣膜2例（6.7％）影响升主动脉。植被的范围从小到容易遗漏的不规则点到大的真菌群。10例（33％）患者发展为主动脉脓肿，其中2例患有动脉瘤，13例（43％）患有冠状动脉脓栓栓塞伴微脓肿和心肌微梗塞，2例（6.7％）治愈的心内膜炎伴穿孔和反流伴心室重塑。13例（43％）可识别出潜在的瓣膜异常或置换，最常见的是二尖瓣主动脉瓣膜（7; 54％）。

结论

这项研究强调，尽管心内膜炎少见，但在瓣膜正常，瓣膜疾病和瓣膜置换手术的患者中，SCD的重要病因。在我们的队列研究中，没有死前诊断的人群中有70％突出显示了在尸检时需要对心脏和心脏瓣膜进行详细分析的必要性。植被的总体外观差异很大，可能会被遗漏。需要明确相关的心脏并发症，以阐明死亡原因，这将为临床医生提供宝贵的经验教训。