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Risk of infective endocarditis in patients with mitral valve prolapse : systematic review with meta-analysis
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Introdução: Endocardite infeciosa (EI) é uma condição cardíaca severa associada a complicações graves. Apesar de já ter sido reportado que o prolapso da válvula mitral (PVM) está associado a um maior risco de EI, a magnitude desta relação não está bem definida. Por essa razão, esta revisão tem como objetivo compreender se doentes com PVM têm efetivamente um risco superior de desenvolver EI ao da população geral, quantificando esse risco. Métodos: Foi realizada uma meta-análise utilizando os estudos de caso-controlo e coorte disponíveis na literatura, que reportavam EI em doentes com PVM. Ambos os diagnósticos foram aceites com base no julgamento clínico. A pesquisa foi realizada em várias bases de dados (MEDLINE, Cochrane Library (CENTRAL) e Web of Science). Uma meta-análise de efeitos aleatórios foi realizada, estimando o odds-ratio (OR) dos estudos elegíveis, com um intervalo de confiança de 95%. A heterogeneidade foi pesquisada pelo teste I2. O risco de enviesamento dos estudos foi analisado com a escala Newcastle- Ottawa. Resultados: Foram considerados elegíveis um total de seis estudos, e os resultados demonstraram que os doentes com PVM tinham um risco superior ao da população geral de desenvolver EI (OR 7.83, 95% CI 5.11, 12.02; I2 = 0%). As análises posteriores realizadas tendo em conta o risco de enviesamento dos estudos considerados e o seu desenho não mostraram alterações relevantes em relação ao resultado obtido, fortalecendo as conclusões obtidas. Conclusão: Os resultados obtidos podem ter implicações no que toca à profilaxia antibiótica atualmente recomendada para a EI. Para reforçar ainda mais este resultado, estudos contemporâneos deveriam ser realizados, tendo em conta os critérios de diagnóstico atuais.
Introduction: Infective endocarditis (IE) is a serious heart condition. Although it has been reported that mitral valve prolapse (MVP) leads to a higher risk of IE, the magnitude of this relation is not well described. This review aims to better comprehend if patients with MVP have a higher risk of developing IE than the general population. Methods: A meta-analysis was conducted, using the available cohort and case-control studies reporting IE in patients with and without MVP. Both IE and MVP diagnoses were accepted based on clinical medical judgement. MEDLINE, Cochrane Library (CENTRAL) and Web of Science databases were searched electronically to find all the relevant data. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were derived by random effects meta-analysis. Heterogeneity was assessed using the I2 test. The quality of reporting was analyzed by the Newcastle–Ottawa Scale. Results: A total of six studies were considered eligible, and the obtained results showed that MVP patients had a higher risk of IE when compared to the general population (OR 7.83, 95% CI 5.11, 12.02; I2 = 0%). Posterior analysis according to the risk of bias and study design didn’t show any significant variations in the direction and magnitude of the effect. Conclusions: These results could have further implications regarding the current antibiotic prophylaxis recommendations. To strengthen our findings, contemporary studies should be conducted in the future, using current diagnostic guidelines.
Introduction: Infective endocarditis (IE) is a serious heart condition. Although it has been reported that mitral valve prolapse (MVP) leads to a higher risk of IE, the magnitude of this relation is not well described. This review aims to better comprehend if patients with MVP have a higher risk of developing IE than the general population. Methods: A meta-analysis was conducted, using the available cohort and case-control studies reporting IE in patients with and without MVP. Both IE and MVP diagnoses were accepted based on clinical medical judgement. MEDLINE, Cochrane Library (CENTRAL) and Web of Science databases were searched electronically to find all the relevant data. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were derived by random effects meta-analysis. Heterogeneity was assessed using the I2 test. The quality of reporting was analyzed by the Newcastle–Ottawa Scale. Results: A total of six studies were considered eligible, and the obtained results showed that MVP patients had a higher risk of IE when compared to the general population (OR 7.83, 95% CI 5.11, 12.02; I2 = 0%). Posterior analysis according to the risk of bias and study design didn’t show any significant variations in the direction and magnitude of the effect. Conclusions: These results could have further implications regarding the current antibiotic prophylaxis recommendations. To strengthen our findings, contemporary studies should be conducted in the future, using current diagnostic guidelines.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Endocardite infeciosa Prolapso da válvula mitral Cardiologia