Echocardiographic Findings Suggestive of Infective Endocarditis in Asymptomatic Danish Injection Drug Users Attending Urban Injection Facilities
Echocardiographic Findings Suggestive of Infective Endocarditis in Asymptomatic Danish Injection Drug Users Attending Urban Injection Facilities
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DOI：
10.1016/j.amjcard.2014.04.010
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发表时间：
2014-07-01
影响因子：
2.8
通讯作者：
Iversen, Kasper
中科院分区：
文献类型：
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作者：
Axelsson, Anna;Soholm, Helle;Iversen, Kasper
注射吸毒者（IDUs）占感染性心内膜炎（IE）住院治疗的相当数量，但在IDUs中诊断和未识别的IE的患病率是未知的。本研究的目的是评估在接受监督注射设施的注射吸毒者中提示IE的瓣膜异常的患病率。我们在注射设施现场进行了经胸超声心动图检查。总共纳入了206名注射吸毒者（平均年龄43 ± 9岁，23%为女性），注射药物滥用中位数为18年（四分位距10至26）。14名注射吸毒者（14/206，7%，95%置信区间[CI] 4%-11%）有IE既往史。有IE病史的注射吸毒者明显比无IE病史的注射吸毒者年龄大（分别为48 +/- 8 vs 42 +/- 9岁，p = 0.03），注射吸毒的持续时间更长（27 [18 - 36] vs 17年[10 - 25]，p = 0.008）。在有IE病史的IDUs亚组中，4例受试者（4/14，29%，95% CI 11%-55%）有持续性或复发性赘生物。在其余10例有IE病史的IDU中，5例（5/10，50%，95% CI 24%-76%）有中度至重度返流。在无IE病史的IDUs亚组中，9例受试者观察到赘生物（9/192，5%，95% CI 2%-9%）。这组可能未被识别的IE的IDUs比没有赘生物的IDUs年龄大（分别为48 +/- 12 vs 42 +/- 9，p = 0.04）。在无IE病史且无赘生物的IDUs中，30名IDUs（30/183，16%，95% CI 11%-22%）有中度至重度返流，伴或不伴瓣叶增厚。因此，在无IE病史的IDUs中，在20%（39/192，95% CI 15%-27%）的受试者中观察到一定程度的瓣膜异常。没有一个有瓣膜赘生物的静脉吸毒者有与活动性IE一致的当前症状。总之，超声心动图评估的瓣膜异常在无IE病史的无症状注射吸毒者中普遍存在，在5%的受试者中观察到赘生物。(C)2014年爱思唯尔公司All rights reserved.
Injection drug users (IDUs) account for a considerable number of the hospitalizations for infective endocarditis (IE), but the prevalence of diagnosed and unrecognized IE in IDUs is unknown. The aim of the present study was to assess the prevalence of valvular abnormalities suggestive of IE in IDUs attending a supervised injection facility. We performed transthoracic echocardiographic examinations on-site in the injection facilities. A total of 206 IDUs (mean age 43 +/- 9 years, 23% women) with a median injection drug abuse of 18 years (interquartile range 10 to 26) were included. Fourteen IDUs (14 of 206, 7%, 95% confidence interval [CI] 4% to 11%) had a previous history of IE. IDUs with a history of IE were significantly older than IDUs without a history of IE (48 +/- 8 vs 42 +/- 9 years, respectively, p = 0.03) and had a longer duration of injection drug use (27 [18 to 36] vs 17 years [10 to 25], p = 0.008). In the subgroup of IDUs with a history of IE, 4 subjects (4 of 14, 29%, 95% CI 11% to 55%) had persistent or relapse vegetations. Of the remaining 10 IDUs with a history of IE, 5 (5 of 10, 50%, 95% CI 24% to 76%) had moderate-to-severe regurgitation. In the subgroup of IDUs without a history of IE, vegetations were seen in 9 subjects (9 of 192, 5%, 95% CI 2% to 9%). This group of IDUs with possibly unrecognized IE was older than IDUs without vegetations (48 +/- 12 vs 42 +/- 9, respectively, p = 0.04). Among the IDUs without a history of IE who did not have vegetations, 30 IDUs (30 of 183, 16%, 95% CI 11% to 22%) had moderate-to-severe regurgitation with or without concomitant thickening of leaflets. Thus, in IDUs without a history of IE, some extent of valvular abnormalities was seen in 20% (39 of 192, 95% CI 15% to 27%) of subjects. None of the IDUs with valvular vegetations had current symptoms consistent with active IE. In conclusion, valvular abnormalities assessed by echocardiography were prevalent in asymptomatic IDUs without a medical history of IE, and vegetations were seen in 5% of subjects. (C) 2014 Elsevier Inc. All rights reserved.