Among 241 consecutive patients with infective endocarditis (IE) (age 51.3±16.7 years), 131 (54.4%) had no past medical history of cardiac diseases (group 1). Compared to patients with previous history of cardiac disease (group 2), patients in group 1 were characterized by higher prevalence of malignancy (odds ratio [OR]=5.44, 95% confidence interval [CI]=1.55-19.18, p=0.011) and peripheral embolism not involving central nervous system (OR=1.86, 95% CI=1.06-3.29, p=0.025). Size and location of vegetation was not different between groups. S. viridians was the most common causative microorganism in both groups (35.1 vs 41.8%, p=0.291) and S. aureus the second common (29.8 vs 19.1%, p=0.072). Underlying cardiac diseases in group 2 included previous valve surgery (35.5%), ventricular septal defect (20.9%), mitral valve prolapse (MVP) (14.5%), rheumatic (11.8%) and degenerative (7.3%) aortic valve (AV) disease, and congenital bicuspid AV (5.5%). In group 1, vegetations involving normal looking MV and AV was the most common echocardiographic abnormality (44.3%) and other lesions included MVP (25.2%), degenerative (9.2%) and rheumatic AV disease (6.9%), AV prolapse (5.3%), and bicuspid AV (1.5%). The survival was not different between groups. In group 1, S. aureus infection (hazard ratio [HR]=3.13, 95% CI=1.51-6.6, p=0.001), diabetes mellitus (HR=2.75, 95% CI=1.20-6.28, p=0.009), chronic kidney disease (HR=6.36, 95% CI=1.92-21.00, p=0.002) and liver cirrhosis (HR=5.23, 95% CI=1.89-14.453, p=0.002) were independent predictors for mortality. In group 2, S. aureus infection (HR=2.87, 95% CI=1.14-7.22, p=0.025) was the only predictor.
Conclusion: In significant proportion of patients with IE, IE is the first clinical presentation without clinically recognized cardiac diseases. They have strong trend of involvement of apprently normal looking valve and different demographic features including underlying medical illnesses and predictors of mortality.
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