The clinical and pathological features of patients with infective endocarditis diagnosed at autopsy

Abstract

Objective: To study the characteristics and misdiagnosis of infective endocarditis (IE). Methods: Clinical and pathological data of 15 IE patients diagnosed by autopsy were collected, compared with the cohort of 29 regular IE cases. Results: In the autopsy patients, IE in the left heart was predominat (14/15, 93.3%). Arterial embolism was the most common comorbidity (10/15, 66.7%), followed by pneumonia, malignancies, pyelonephritis (9/15, 60.0%; 7/15, 46.7%; 6/15, 40.0% respectively). The age was elder [(64.0±21.2)years vs(50.8±18.3)years, t=-2.15, P=0.037] in autopsy patients than in control group. More patients of missed diagnosis were combined with malignancies or deep vein catheterization [7/15(46.7%)vs 1/29(3.4%); 5/15(33.3%)vs 0/29(0)respectively]. Fever and cardiac murmur were rare in misdiagnosed cases[11/15(73.7%)vs 28/29(96.9%), 0/15(0)vs 15/29(51.7%) respectively]. Echocardiography and blood culture were performed in only 33.3%(5/15) and 26.7%(4/15) cases of missed diagnosis with low positive rates compared with regular IE patients [0/15(0) vs 27/29 (93.1%); 1/15(6.7%) vs 15/29(55.6%)]. Conclusions: Infective endocarditis should be suspected in patients with the risk factors of IE even without fever or cardiac murmur. Echocardiography and blood culture should be done as screening tests of IE.