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

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

Edité par CCSD ; Elsevier -

International audience. 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 two groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right-non-coronary or left-non-coronary (non-RL type) cusp fusion. All patients were followed up for 1 year.Results: 138 patients with BAVIE were included [male 77.7%; 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=0.032) and NYHA class ≥II (64.3% vs 42.3%; p=0.039) 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=0.034) and high-grade atrio-ventricular block (11.5% vs 0.9%; p=0.021). 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=0.045). 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.

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