AB0876 GOUT CAUSING URATE CARDIAC VEGETATIONS: SUMMARY OF PUBLISHED CASES

Abstract

Background Gout is a progressive inflammatory disease that is both widely prevalent and widely undertreated. In gout patients, urate deposition occurs in peripheral joints, the spine, and organs including the prostate, kidneys, and in atherosclerotic plaques as well as heart valves. Due to the concern of bacterial endocarditis and associated sequelae, cardiac valve vegetations are generally thoroughly evaluated even without systemic symptoms. Gout causing cardiac valvular vegetations is believed to be rare, though to date a number of case reports on this topic have been published. Objectives This project sought to compile and synthesize the existing published cases of proven cardiac valve urate deposition in gout patients. Methods Medline and google were used to search for all available published cases involving gout associated with or causing cardiac valve vegetations. The references of each publication were additionally completely examined to find any other cases that may not have been identified on previous searches. The case reports were obtained and patient, disease, and valve factors were compiled and synthesized. Results Eight publications were found from 1954 to 2012 reporting 9 cases of urate deposition on cardiac valves. All cases had known tophaceous gout, mean age 60.9, and 89% were male. The mean uric acid level was 10.2 mg/dL, 4/9 (44%) reported a heart murmur, and in only one (11%) of the nine cases was infective endocarditis suspected. The diagnosis of gouty valvular involvement came from autopsy in 4 patients (44%), pathological report in 3 patients (33%), and was a diagnosis of exclusion after transthoracic echocardiogram in two patients (22%). The mitral valve was the most commonly involved heart valve, with 6 of the 9 gout patients (66%) with urate valvular deposits having them on the mitral valve. One patient had aortic and another had pulmonic valve involvement, while no patients were found to have tricuspid urate deposits from gout. Conclusion Though gout generally causes urate deposition in peripheral joints, urate deposits have been found in organs including the prostate, heart, kidneys, and eyes. Urate deposits from gout in heart valves are quite rarely reported, and this project describes 9 cases of urate valvular deposition associated with gout from 8 case report publications dating back to 1954. Based on these findings, urate deposition from gout on a cardiac valve will primarily remain a rare diagnosis of exclusion, but should be considered in patients with known longstanding visibly tophaceous gout, hyperuricemia, mitral valve involvement, and a lack of systemic signs or symptoms of infective endocarditis.