高齢者の感染性心内膜炎

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タイトル別名
  • Infective Endocarditis in the Elderly.
  • コウレイシャ ノ カンセンセイシン ナイ マクエン

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To elucidate clinical features of infective endocarditis in the elderly, 20 elderly patients aged ≥60 years were compared in detail with 30 others aged <60 years retrospectively. Twelve of the 20 elderly patients had a calcific aortic valve or an artificial device as a predisposing heart disease, whereas 16 middle-aged patients had mitral valve prolapse or congenital heart disease (p=0.001). The prevalence of major extracardiac disorders such as neurological disease were higher in the elderly than in the middle (9/20 vs 3/30; p<0.01). The frequency of infected valve was similar; mitral in 8, aortic in 11 and other valves or congenital defect in 2 in the elderly versus 14, 11 and 6, respectively in the middle. Among 39 patients in whom causative microorganisms were identified, staphylococcus epidermidis was most frequently identified in the elderly (5/20), whereas streptococcus species was found in the middle (12/30). Time from the onset of symptoms to correct diagnosis was usually delayed in the entire group; the delay was longer particularly in the elderly than in the middle-aged patients (72±87 vs 36±32 days; p<0.1). Maximal body temperature was less in the elderly than in the middle-aged patients (38.5±0.7 vs 39.3±1.1°C; p<0.01), whereas peak level of C-reactive protein (10.4±6.1 vs 13.0±7.9mg/dL), the incidences of heart failure (9/20 vs 10/30), and embolic complications (7/20 vs 10/20) were similar in the 2 groups. Cardiac operation was performed less in the elderly than in the middle-aged patients (9/20 vs 21/30; p<0.08). Five elderly patients had disease-related mortality, whereas only one middle-aged patient died (p=0.02). These results suggest that although predisposing heart disease and causative microorganism in infective endocarditis are different between the elderly and middle-aged patients, the incidence of major complications are similar. However, due to the delay of correct diagnosis in the elderly who usually have major extracardiac disorders, the prognosis of infective endocarditis in the elderly is poor.

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