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Heartbeat: knowledge gaps for non-bacterial thrombotic endocarditis
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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Non-bacterial thrombotic endocarditis (NBTE) contributes to adverse outcomes in patients with systemic inflammatory conditions, antiphospholipid syndrome or advanced malignancy (figure 1). Diagnosis is challenging and there is little data to guide prevention of adverse events, particularly stroke. In this issue of Heart, Quintero-Martinez and colleagues1 report the clinical characteristics and outcomes in 48 adults with NBTE identified at the Mayo Clinic over a 7 year period. Most patients (75%) were women with a mean age of 60 years and most cases were associated with malignancy (52%) or a systemic inflammatory disease (38%). Adverse events included moderate-severe valve regurgitation (54%), systemic embolic events (54%) and a 1 year mortality of 33%, often related to the underlying malignancy.

Figure 1

Transoesophageal echocardiographic images of non-bacterial thrombotic endocarditis. (A) Zoomed mid-oesophageal four-chamber view in systole showing a thickened mitral valve with stuck-on kissing lesions on the leaflet tips (arrow). (B) Zoomed mid-oesophageal five-chamber view in diastole illustrating the stuck-on kissing lesion on the anterior mitral valve leaflet tip (arrow). (C) Zoomed mid-oesophageal two-chamber view in diastole depicting the stuck-on kissing lesion on the tip of the posterior mitral valve leaflet (arrow).

In the accompanying editorial, Langston and colleagues2 point out early clinical series of NBTE patients were based on autopsy data. In studies based on echocardiographic findings, such as the current publication,1 imaging findings thought to be NBTE might actually be …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.