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Original research
Contemporary demographics, diagnostics and outcomes in non-bacterial thrombotic endocarditis
  1. Juan A Quintero-Martinez1,2,
  2. Joya-Rita Hindy2,
  3. Said El Zein2,
  4. Hector I Michelena1,
  5. Vuyisile T Nkomo1,
  6. Daniel C DeSimone1,2,
  7. Larry M Baddour1,2
  1. 1Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  2. 2Department of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  1. Correspondence to Dr Juan A Quintero-Martinez, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; quinteromartinez.juan{at}mayo.edu

Abstract

Objective Non-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients.

Methods Adults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up.

Results Forty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively).

Conclusions NBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.

  • Echocardiography
  • Endocarditis

Data availability statement

Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly because the privacy of the individuals who participated in the study must be maintained and because the data underlying this article were provided by Mayo Clinic under licence and by permission. The data will be shared at reasonable request to the corresponding author with the permission of Mayo Clinic.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly because the privacy of the individuals who participated in the study must be maintained and because the data underlying this article were provided by Mayo Clinic under licence and by permission. The data will be shared at reasonable request to the corresponding author with the permission of Mayo Clinic.

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Footnotes

  • Contributors JAQ-M and LMB conceptualised and designed the study. JAQ-M had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JAQ-M and LMB wrote the draft of the manuscript. JAQ-M designed and created all figures. J-RH, SEZ, HIM, VTN and DCD critically reviewed the paper and provided advice. All authors approved the final submitted research manuscript and agree to be personally accountable for their contribution and for the academic integrity of the work. LMB acts as the guarantor.

  • 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 LMB reports the following: UpToDate, royalty payments (authorship duties); Boston Scientific, consultant duties; Botanix Pharmaceuticals, consulting duties; Roivant Sciences, consultant duties. None of the other authors had disclosures.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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