SPECIAL SECTION: LETTER TO THE EDITOR
Reply
Shunichi Homma, MD, FACC and
Cairistine Grahame-Clarke, MRCP, PhD
Cardiology Division, Columbia-Presbyterian Medical Center, 630 West 168th St., New York, NY, USA 10032
sh23{at}columbia.edu
We thank Dr. Mansi for his comments and welcome the chance to summarize the literature on this subject. Older studies published prior to 1980 showed a high percentage of those with Staphylococcal endocarditis sustaining embolic or neurological complications; however, no statistical comparisons with other organisms were made (1–3). For the most part, recent studies have reported no significant difference in the incidence of embolization among different underlying infective organisms (4–9). However, two of these studies did show a higher rate of embolic complications in cases caused by Staphylococcus aureus as compared to Streptococcus viridans (8,9). A large series of patients with left-sided endocarditis showed that overall S. aureus endocarditis had an embolic rate 2.4-fold greater than that with S. viridans endocarditis (10). Other investigators have reported a significant association between Staphylococcal endocarditis and embolization in cases selected by transesophageal echocardiography (11), where all neurological complications were considered together (12,13), or where intracranial hemorrhage alone was considered (14). Also, although the reported incidence of embolization in fungal and enterococcal endocarditis is high, numbers in any given series are small (1–3,15).
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References
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1. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine (Baltimore). 1978;57:329–343[Medline]
2. Garvey GJ, Neu HC. Infective endocarditis—an evolving disease. A review of endocarditis at the Columbia-Presbyterian Medical Center, 1968–1973. Medicine (Baltimore). 1978;57:105–127[Medline]
3. Cherubin CE, Neu HC. Infective endocarditis at the Presbyterian Hospital in New York City from 1938–1967. Am J Med. 1971;51:83–96[CrossRef][Medline]
4. Mugge A, Daniel WG, Frank G, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol. 1989;14:631–638[Abstract]
5. Sanfilippo AJ, Picard MH, Newell JB, et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol. 1991;18:1191–1199[Abstract]
6. Vilacosta I, Graupner C, San Roman JA, et al. Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol. 2002;39:1489–1495[Abstract/Free Full Text]
7. Castillo JC, Anguita MP, Ramirez A, et al. Long-term outcome of infective endocarditis in patients who were not drug addicts: at 10-year study. Heart. 2000;83:525–530[Abstract/Free Full Text]
8. Heinle S, Wilderman N, Harrison JK, et al. Value of transthoracic echocardiography in predicting embolic events in active infective endocarditis. Duke Endocarditis Service. Am J Cardiol. 1994;74:799–801[CrossRef][Medline]
9. De Castro S, Magni G, Beni S, et al. Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. Am J Cardiol. 1997;80:1030–1034[CrossRef][Medline]
10. Steckelberg JM, Murphy JG, Ballard D, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med. 1991;114:635–640[Abstract/Free Full Text]
11. Di Salvo G, Habib G, Pergola V, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol. 2001;37:1069–1076[Abstract/Free Full Text]
12. Le Cam B, Guivarch G, Boles JM, Garre M, Cartier F. Neurologic complications in a group of 86 bacterial endocarditis. Eur Heart J. 1984;5(Suppl C):97–100
13. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. 2000;160:2781–2787[Abstract/Free Full Text]
14. Hart RG, Kagan-Hallet K, Joerns SE. Mechanisms of intracranial hemorrhage in infective endocarditis. Stroke. 1987;18:1048–1056[Abstract/Free Full Text]
15. Utley JR, Mills J, Hutchinson JC, Edmunds LH Jr, Sanderson RG, Roe BB. Valve replacement for bacterial and fungal endocarditis: a comparative study. Circulation. 1973;48(Suppl 3):42–47
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