A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes

Zmaili, Mohammad; Alzubi, Jafar; Koçyiğit, Duygu; Bansal, Agam; Samra, Gursharan; Grimm, Richard A.; Griffin, Brian P.; Xu, Bo

doi:10.1016/j.amjmed.2020.06.047

Cited by 62 publications

(91 citation statements)

References 29 publications

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“…2 Two-thirds of patients (n = 28, 66.7%) presented this way in our study, with the cerebral (n = 25) and coronary circulations (n = 3) being the major targets. 1 Heart failure symptoms and signs at presentation, which were also reported in prior case reports, 3,4 were observed in 9 of 42 patients (21.4%) in our study. 1 In terms of other presentations, these included vague symptoms or nonspecific signs as described in previous case reports, 5 such as altered mental status, dizziness, and generalized weakness.…”

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confidence: 87%

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Zmaili

Alzubi

Koçyiğit

et al. 2021

The American Journal of Medicine

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confidence: 87%

“…We thank Dr Watanabe for his interest in our work. 1 To better illustrate the initial presentations and management strategies for our cohort of patients with nonbacterial thrombotic endocarditis (NBTE), a brief summary is shown in the Table.…”

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confidence: 99%

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Zmaili

Alzubi

Koçyiğit

et al. 2021

The American Journal of Medicine

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“…Reasons for surgical intervention were severe valvular regurgitation, the large size of the vegetation (>2 cm), and recurrent embolic strokes. 17 None of these was present in our patient.…”

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confidence: 60%

“…NBTE associated with malignancy showed a 40% survival rate at 6 months, while NBTE not associated with malignancy revealed a 40% survival rate at 6 years. 17 The fact that our patient had low-grade carcinoma, however, makes our case difficult to compare. Life-long anticoagulation therapy is recommended to lower the risk of recurrent thromboembolism.…”

Section: Discussionmentioning

confidence: 82%

Non-bacterial thrombotic endocarditis manifested by ventricular fibrillation in a patient with low grade ovarian carcinoma: case report and literature review

Kuipers¹,

Berghuis

Ogilvie

et al. 2021

European Heart Journal - Case Reports

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Background Non-bacterial thrombotic endocarditis (NBTE) is a rare form of endocarditis notably described in patients with advanced malignancy and auto-immune diseases. It is characterized by the formation of sterile, fibrin-containing vegetations on cardiac endothelium, in the absence of positive blood cultures. It is predominantly located on the mitral- and aortic valve (AV). Vegetations in NBTE are prone to embolize. Trousseau syndrome (TS) is defined as unexplained thrombotic events that precede the diagnosis of malignancy. Case summary A 49-year-old pre-menopausal woman with a history of visual disturbances, recurrent deep vein thrombosis (DVT) with concurrent pulmonary emboli (PE), and uterine myomas with dysfunctional uterine bleeding was resuscitated for ventricular fibrillation. While echocardiography revealed vegetations on the AV, blood cultures remained negative. Additional work-up for the aetiology of sterile vegetations revealed a low-grade ovarian carcinoma. Cardiac analysis showed evidence of myocardial infarction in the absence of coronary atherosclerosis as a cause for ventricular fibrillation. Discussion Unexplained thrombotic events (venous, arterial, or both) warrant further investigation, e.g., with regard to TS. NBTE is a potential source of thromboembolism in TS and a rare ante-mortem finding, which prompts additional investigation of the underlying cause. In our patient, a triad of (suspected) (i) arterial/systemic embolization (i.e. visual disturbances, splenic infarction, coronary embolism), (ii) peripheral thrombophlebitis/hypercoagulability (i.e. DVT and PE), and (iii) malignancy (i.e. gynaecological abnormalities) raised suspicion of NBTE in the setting of TS. Early diagnosis and treatment of NBTE is of importance due to the high incidence of embolization, with possible fatal outcome.

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“…Large clinical studies related to NTBE are limited because of its rarity. In 2020, a single-center retrospective study described the clinical characteristics of 42 patients with NTBE [8]. The most underlying disease was malignancy (17 cases, 40.5%), followed by antiphospholipid antibody syndrome (15 cases, 35.7%) and systemic lupus erythematosus (14 cases, 33.3%).…”

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confidence: 99%

Nonbacterial Thrombotic Endocarditis Associated with Acute Promyelocytic Leukemia: An Autopsy Case Report

Hashimoto

Aoki

Kawabata³

et al. 2021

Medicina

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Valve vegetation is one of the most fearful findings for physicians. The first diagnosis that comes to their mind is infective endocarditis (IE), but it can also be noninfective; nonbacterial thrombotic endocarditis (NBTE). NBTE can be even more challenging than IE for physicians because of the wide range of differential diagnoses such as malignancies, autoimmune disorders and human immunodeficiency virus. A 45-year-old woman presented at the emergency room with a sudden onset of dysarthria and right-sided hemiplegia. Laboratory data showed her blood counts and coagulation test were mostly normal and the magnetic resonance imaging detected a high-signal-intensity change in her left brain. An echocardiogram found a vegetation-like structure on her atrial valve. We highly suspected IE leading to cerebral embolism. The clot was successfully removed by our neurosurgeons and anticoagulation therapy was started concurrently. Her state of consciousness improved, but then she suffered a brain hemorrhage and died. The autopsy revealed that the cause of her vegetation was acute promyelocytic leukemia (APL). Based on these findings, it is important to remember that APL can be the cause of NBTE even if the blood count and coagulation tests are almost normal.

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A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes

Cited by 62 publications

References 29 publications

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Non-bacterial thrombotic endocarditis manifested by ventricular fibrillation in a patient with low grade ovarian carcinoma: case report and literature review

Nonbacterial Thrombotic Endocarditis Associated with Acute Promyelocytic Leukemia: An Autopsy Case Report

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